Healthcare Provider Details

I. General information

NPI: 1639031354
Provider Name (Legal Business Name): JOHN PAUL KRUEGER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 SW CANAL BLVD STE 101
REDMOND OR
97756-2228
US

IV. Provider business mailing address

1380 SW CANAL BLVD STE 101
REDMOND OR
97756-2228
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-6224
  • Fax: 541-797-6274
Mailing address:
  • Phone: 541-797-6224
  • Fax: 541-797-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6492
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: