Individual provider Active NPI

Robert Steven Kreutz Jr., B.S., D.C.

  • Chiropractor
  • Lynnwood, WA
National Provider Identifier
1053319459
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3134 Issued in WA
Practice address
13619 Mukilteo Speedway Ste B4
Lynnwood, WA 98087-1671
Phone
(425) 353-1011
Fax
(425) 353-1033
NPI assigned
Jul 9, 2005
Last updated
Nov 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3134 WA Primary

Addresses

Primary practice location

13619 Mukilteo Speedway Ste B4
Lynnwood, WA 98087-1671

Mailing address

215 79TH PL SW
Everett, WA 98203-6218
Phone (425) 387-2556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090716000364 WA Practitioner - Chiropractic 4688726029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

13624 Hwy 99
Suite B4
Lynnwood, WA 98087-1656
Phone (425) 353-1011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
3134WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Bothell Regenerative Medicine Past Accepting new patients
Kaufman Chiropractic Clinic Inc Chiropractor PastSince Feb 18, 2013 Accepting new patients

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1053319459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 79TH PL SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036218",
            "telephone_number": "425-387-2556",
            "fax_number": "425-353-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13619 MUKILTEO SPEEDWAY STE B4",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980871671",
            "telephone_number": "425-353-1011",
            "fax_number": "425-353-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREUTZ",
        "first_name": "ROBERT",
        "middle_name": "STEVEN",
        "name_suffix": "Jr.",
        "credential": "B.S., D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-09",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "3134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.