Provider Demographics
NPI:1487779534
Name:KROLL, BRIAN ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANTHONY
Last Name:KROLL
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 1:305 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2527
Mailing Address - Country:US
Mailing Address - Phone:651-388-4378
Mailing Address - Fax:651-388-4385
Practice Address - Street 1:305 BUSH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2527
Practice Address - Country:US
Practice Address - Phone:651-388-4378
Practice Address - Fax:651-388-4385
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003198Medicare ID - Type UnspecifiedPROVIDER ID