Provider Demographics
NPI:1063523322
Name:KEVIN KROES CHIROPRACTIC CORP
Entity type:Organization
Organization Name:KEVIN KROES CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KROES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-862-7499
Mailing Address - Street 1:18017 SKY PARK CIR
Mailing Address - Street 2:STE. F
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6519
Mailing Address - Country:US
Mailing Address - Phone:949-862-7499
Mailing Address - Fax:949-862-7496
Practice Address - Street 1:18017 SKY PARK CIR
Practice Address - Street 2:STE. F
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6519
Practice Address - Country:US
Practice Address - Phone:949-862-7499
Practice Address - Fax:949-862-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare UPIN
CADC23037Medicare ID - Type Unspecified