DR. CODY LEE KRUCKENBERG (NPI# 1790175388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790175388 |
| Entity Type | Individual |
| Full Name | DR. CODY LEE KRUCKENBERG |
| Credential | D.C. |
| Practice Address |
312 E Holly Blvd Brandon SD 57005 |
| Mailing Address |
312 E Holly Blvd Brandon SD 57005-1240 |
| Practice Telephone | 6052547735 |
| Mailing Telephone | 6052547735 |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2018-05-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 1333 | SD | Chiropractic Providers |
| N | 111N00000X | Chiropractor | 600 | AK | Chiropractic Providers |
| Street Address |
312 E HOLLY BLVD |
| City | BRANDON |
| State | SD |
| Zip Code | 57005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740778422 | Fit for Life Chiropractic, LLC | Chiropractor | 312 E Holly Blvd, Brandon, SD 57005-1240 | 2018-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144794926 | Sarah Hewitt | Counselor | 316 E Holly Blvd, Brandon, SD 57005 | 2019-01-15 |
| 1356577159 | Matthew Krivarchka | Dentist | 1511 W. Holly Boulevard, Brandon, SD 57005 | 2009-06-08 |
| 1851546253 | Karla Karrin Jorgenson | Occupational Therapist | 103 North Splitrock Blvd, Brandon, SD 57005 | 2008-11-26 |
| 1598954364 | David Fitzgerald Ward Dc | Chiropractor | 1302 E Rushmore, Brandon, SD 57005 | 2007-10-17 |
| 1477675437 | Kara Lynn Baas | Counselor | 1320 E Rushmore Drive, Suite 107, Brandon, SD 57005 | 2007-04-03 |
| 1124161773 | Michael R Juba | Dentist | 704 N Splitrock Blvd, Brandon, SD 57005 | 2007-02-14 |
| 1548334246 | Med Star Paramedic Inc | Non-emergency Medical Transport (VAN) | 922 E Redwood Blvd, Brandon, SD 57005 | 2006-11-17 |
| 1386723468 | Prairie Rehabilitation Services, Inc. | Durable Medical Equipment & Medical Supplies | 1220 E. Holly Blvd, Brandon, SD 57005 | 2006-11-02 |
| 1396780698 | Barbara Harvison | Physician Assistant | 1101 E Holly Blvd, Brandon, SD 57005 | 2006-06-19 |
| 1326121807 | David Fitzgerald Ward | Chiropractor | 1302 E Rushmore Dr, Brandon, SD 57005-0408 | 2006-10-20 |
| Find all providers in zip 57005 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013419563 | Brandon Family Chiropractic LLC | Chiropractor | 1350 West Government Street Suite A1, Brandon, MS 39042 | 2018-03-01 |
| 1932569704 | Haley Wilson | Chiropractor | 1350 W Government St Ste A1, Brandon, MS 39042 | 2016-03-07 |
| 1538541552 | New Day Chiropractic and Health Solutions,llc | Chiropractor | 125 Hollybush Pl, Brandon, MS 39047-7332 | 2015-06-25 |
| 1881943900 | Kennedy Chiropractic Clinic Inc | Chiropractor | 393 Crossgates Blvd, Suite B, Brandon, MS 39042 | 2012-09-05 |
| 1366719619 | Ronald Jack Travis Utter | Chiropractor | 1355 Oakfield Dr, Brandon, FL 33511-4841 | 2011-11-30 |
| 1669776985 | Amanda Michelle Lenth | Chiropractor | 1806 Sterling Palms Ct Apt 302, Brandon, FL 33511-1728 | 2010-12-29 |
| 1073844684 | Vanessa Nichola Benton | Chiropractor | 500 Vonderburg Dr Ste 105, Brandon, FL 33511-5968 | 2010-01-21 |
| 1477788917 | Chad Franklin Polley | Chiropractor | 166 E Bloomingdale Ave, Suite B, Brandon, FL 33511-8101 | 2009-05-28 |
| 1104079466 | Richard E. Rogovin, Dc, Pa | Chiropractor | 506 Westbrook Ave, Brandon, FL 33511-5316 | 2008-10-30 |
| 1396909792 | Shanelle Etienne | Chiropractor | 920 W. Lumsden Rd, Brandon, FL 33511 | 2008-07-15 |
| Find all providers in BRANDON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.