=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972741445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVELAND CHIROPRACTIC OFFICE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2009
-----------------------------------------------------
Last Update Date | 10/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3025 N TAFT AVE STE C
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-8310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-663-3600
-----------------------------------------------------
Fax | 970-663-7674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3025 N TAFT AVE STE C
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-8310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-663-3600
-----------------------------------------------------
Fax | 970-663-7674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD EDWIN KRUGMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 970-663-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1550
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------