Provider Demographics
NPI:1487704011
Name:KROGAN, DIANNE G (DC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:G
Last Name:KROGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10008 MAPLE CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2870
Mailing Address - Country:US
Mailing Address - Phone:612-388-0454
Mailing Address - Fax:
Practice Address - Street 1:5609 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2429
Practice Address - Country:US
Practice Address - Phone:612-824-7012
Practice Address - Fax:612-822-8766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44-86873OtherMEDICA
MN54D34KROtherBCBS
MN823728000Medicaid
MN44-86873OtherMEDICA
MN350001229Medicare ID - Type Unspecified