Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | B01360 | NV |
Y | 111NS0005X | Chiropractic Sports Physician | 5801 | NV |
NPI | 1114245131 |
---|---|
Provider Name | Dr. Job Krugly |
First Address | Henderson, NV 89052-3997 |
Second Address | Henderson, NV 89052-3997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2010 |
Last Update Date | 17/03/2018 |