Provider Demographics
NPI:1699435461
Name:KRUSE, TYLER MORGAN (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MORGAN
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 1:16301 KENRICK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8494
Mailing Address - Country:US
Mailing Address - Phone:525-956-3379
Mailing Address - Fax:
Practice Address - Street 1:16301 KENRICK AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8494
Practice Address - Country:US
Practice Address - Phone:952-959-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557779111N00000X
MN7220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor