Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC.4129DC | SC |
NPI | 1003277328 |
---|---|
Provider Name | Randall Kruel |
First Address | Irwin, PA 15642-4558 |
Second Address | Irwin, PA 15642-4558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2016 |
Last Update Date | 22/03/2016 |