Provider Demographics
NPI:1992414742
Name:KRUKOW, CHANDLER SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:SHANE
Last Name:KRUKOW
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 1:11323 HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-8822
Mailing Address - Country:US
Mailing Address - Phone:641-648-2446
Mailing Address - Fax:641-648-2330
Practice Address - Street 1:11323 HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-8822
Practice Address - Country:US
Practice Address - Phone:641-373-2771
Practice Address - Fax:641-648-2330
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty