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NPI Code Detail

MEDICARE: DR. CHARLES N. KRUEGER D.C.

MEDICARE:  DR. CHARLES N. KRUEGER  D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038-004119IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10001682635OTHERILBLUECROSS BLUE SHIELD

General Provider Information

NPI Number : 1063594026
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES N. KRUEGER D.C.
Provider Business Mailing Address
First Line : 1400 E LAKE COOK RD
Second Line : STE 150
City : BUFFALO GROVE
State : IL
Zip : 60089-8218
Country : US
Telephone Number : 847-537-0300
Fax Number : 847-537-0745
Provider Business Practice Location Address
First Line : 1400 E LAKE COOK RD
Second Line : STE 150
City : BUFFALO GROVE
State : IL
Zip : 60089-8218
Country : US
Telephone Number : 847-537-0300
Fax Number : 847-537-0745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 06/27/2016

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