Provider Demographics
NPI:1366565335
Name:KRALL, MARILEE A (DC)
Entity type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:A
Last Name:KRALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:EM
Other - Middle Name:
Other - Last Name:KRALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2002 HOT SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3441
Mailing Address - Country:US
Mailing Address - Phone:505-454-9525
Mailing Address - Fax:
Practice Address - Street 1:2002 HOT SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3441
Practice Address - Country:US
Practice Address - Phone:505-454-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor