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General NPI Number Information
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NPI Number | 1790986016
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Entity Type | Individual
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Provider Name | LUCAS WAYNE KRUSE D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 6360 ROGERS RD
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City | ROLESVILLE
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State | NC
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Zip | 27571-9371
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Country | US
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Telephone | 919-435-7020
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Fax | 919-435-7134
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Provider Business Mailing Address
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Address Line | 6360 ROGERS RD
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City | ROLESVILLE
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State | NC
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Zip | 27571-9371
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Country | US
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Telephone | 919-679-2850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3797
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License Number State | NC
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