MEDICARE: DR. KENNETH DANIEL KRIEGER D.C.,C.C.S.T.

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	3947	AZ

General Provider Information

NPI Number	:	1649254194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DANIEL KRIEGER D.C.,C.C.S.T.

Provider Business Mailing Address
First Line	:	8201 W VILLA CHULA LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1645
Country	:	US
Telephone Number	:	623-561-2478
Fax Number	:

Provider Business Practice Location Address
First Line	:	8877 W UNION HILLS DR
Second Line	:	SUITE 300
City	:	PEORIA
State	:	AZ
Zip	:	85382-3008
Country	:	US
Telephone Number	:	623-583-8190
Fax Number	:	623-583-8788

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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