Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-011574 | IL |
NPI | 1003103938 |
---|---|
Provider Name | Scott M Cruse |
First Address | Oak Brook, IL 60523-1234 |
Second Address | Oak Brook, IL 60523-1272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 12/12/2013 |