Healthcare Provider Details

I. General information

NPI: 1457459760
Provider Name (Legal Business Name): RALPH B KRUTULIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 NORTH ST
JAMESVILLE NY
13078-9499
US

IV. Provider business mailing address

4613 NORTH ST
JAMESVILLE NY
13078-9499
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-8040
  • Fax: 315-469-8023
Mailing address:
  • Phone: 315-469-8040
  • Fax: 315-469-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: