Organization
KENNETH KRUCHTEN, DC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH KRUCHTEN DC (OWNER)
(815) 432-6201
Entity
Organization
Contact information
Practice address
209 S 5TH ST, WATSEKA, IL 60970-1659
(815) 432-6201
(815) 432-5416
Mailing address
209 S 5TH ST, WATSEKA, IL 60970-1659
(815) 432-6201
(815) 432-5416
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038005663
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038005663
—
IL
01
—
9982032
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/10/2007
Last updated
05/05/2008
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