Provider Demographics
NPI:1194344887
Name:KROGUE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KROGUE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-691-1194
Mailing Address - Street 1:1172 E 100 N STE 9
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1691
Mailing Address - Country:US
Mailing Address - Phone:801-691-1194
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N STE 9
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1691
Practice Address - Country:US
Practice Address - Phone:801-691-1194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty