MEDICARE: MS. DIANNE G KROGAN DC

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
1	111N00000X	Chiropractor	2117	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44-86873	OTHER	MN	MEDICA
2	54D34KR	OTHER	MN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487704011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANNE G KROGAN DC

Provider Business Mailing Address
First Line	:	10008 MAPLE CIR
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-2870
Country	:	US
Telephone Number	:	612-388-0454
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2429
Country	:	US
Telephone Number	:	612-824-7012
Fax Number	:	612-822-8766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	09/04/2008

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