Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 878 | LA |
NPI | 1104855444 |
---|---|
Provider Name | Dr. Mark Bell Kruse |
First Address | Metairie, LA 70006-6527 |
Second Address | Metairie, LA 70006-6527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1936219 | (05) | LA |
T92433 | (02) | LA |