Healthcare Provider Details

I. General information

NPI: 1972530558
Provider Name (Legal Business Name): MICHAEL B KROUSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MADISON AVE SUITE 101
MOORISTOWN NJ
07960
US

IV. Provider business mailing address

95 MADISON AVE SUITE 101
MOORISTOWN NJ
07960
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-1010
  • Fax: 973-267-5521
Mailing address:
  • Phone: 973-267-1010
  • Fax: 973-267-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00354400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00354400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: