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General NPI Number Information
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NPI Number | 1487855078
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Entity Type | Organization
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Legal Business Name | KRUEGER CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 436 SUPERIOR ST
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City | ANTIGO
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State | WI
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Zip | 54409-1855
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Country | US
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Telephone | 715-623-4687
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Fax | 715-623-0697
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Provider Business Mailing Address
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Address Line | 436 SUPERIOR ST
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City | ANTIGO
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State | WI
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Zip | 54409-1855
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Country | US
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Telephone | 715-623-4687
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Fax | 715-623-0697
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. ANDREW CARY KRUEGER
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Credential | D.C.
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Telephone | 715-623-4687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3428012
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License Number State | WI
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