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General NPI Number Information
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NPI Number | 1124210489
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Entity Type | Organization
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Legal Business Name | KENNETH KRUCHTEN, DC
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 209 S 5TH ST
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City | WATSEKA
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State | IL
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Zip | 60970-1659
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Country | US
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Telephone | 815-432-6201
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Fax | 815-432-5416
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Provider Business Mailing Address
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Address Line | 209 S 5TH ST
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City | WATSEKA
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State | IL
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Zip | 60970-1659
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Country | US
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Telephone | 815-432-6201
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Fax | 815-432-5416
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH KRUCHTEN
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Credential | DC
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Telephone | 815-432-6201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038005663
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License Number State | IL
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