Provider Demographics
NPI:1124210489
Name:KENNETH KRUCHTEN, DC
Entity type:Organization
Organization Name:KENNETH KRUCHTEN, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUCHTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-432-6201
Mailing Address - Street 1:209 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1659
Mailing Address - Country:US
Mailing Address - Phone:815-432-6201
Mailing Address - Fax:815-432-5416
Practice Address - Street 1:209 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1659
Practice Address - Country:US
Practice Address - Phone:815-432-6201
Practice Address - Fax:815-432-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005663111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9982032OtherBLUE CROSS BLUE SHIELD
IL038005663Medicaid
ILK23392Medicare PIN
9982032OtherBLUE CROSS BLUE SHIELD
IL038005663Medicaid