Provider Demographics
NPI:1124176367
Name:KRUSE, MICHAEL JAY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 IRON ST STE A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4644
Mailing Address - Country:US
Mailing Address - Phone:360-676-1140
Mailing Address - Fax:360-676-1142
Practice Address - Street 1:1840 IRON ST STE A
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4644
Practice Address - Country:US
Practice Address - Phone:360-676-1140
Practice Address - Fax:360-676-1142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50435OtherLABOR AND INDUSTRIES
WA50435OtherLABOR AND INDUSTRIES