Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 04452 | IA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 04452 | IA |
NPI | 1821077694 |
---|---|
Provider Name | Dr. Mark A Kruse |
First Address | Sioux City, IA 51106-3020 |
Second Address | Sioux City, IA 51106-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1070789 | (05) | IA |
1070789 | TITLE 19 (01) | IA |
49930 | BLUE CROSS (01) | IA |
49930 | BLUE SHIELD (01) | IA |
6070 | SIOUX VALLEY HEALTH (01) | IA |
NE26410 | BLUE CROSS OF NE (01) | NE |
T00565 | (02) | IA |