Provider Demographics
NPI:1386742955
Name:KRUSE, NATHAN HARM (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:HARM
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 1:908 PENNIMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48186
Mailing Address - Country:US
Mailing Address - Phone:734-453-7090
Mailing Address - Fax:
Practice Address - Street 1:908 PENNIMAN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48186
Practice Address - Country:US
Practice Address - Phone:734-453-7090
Practice Address - Fax:734-453-9992
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H229090OtherBCBS OF MICHIGAN
MI421536382OtherCOMMERICAL
MIN53210003Medicare PIN