Individual
DR. JON R. KRUTAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4924 FORT HENRY DR, SUITE E, KINGSPORT, TN 37663-3386
(423) 239-7340
(423) 239-7452
Mailing address
4924 FORT HENRY DR, SUITE E, KINGSPORT, TN 37663-3386
(423) 239-7340
(423) 239-7452
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC1096
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3058747
BLUE CROSS BLUE SHIELD
TN
05
—
3676970
—
TN
01
—
4324698
CIGNA
TN
01
—
P00441207
RAILROAD MEDICARE
TN
01
—
TN0102
UNITED HEALTHCARE
TN
01
—
TN0104
JOHN DEERE
TN
Enumeration date
05/03/2006
Last updated
03/11/2008
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