Geraldine Marie Kruckenberg, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038 007464 Issued in IL

Practice address

1715 5TH Ave
Moline, IL 61265-7911

Phone

(309) 764-9255

Fax

(309) 762-1064

NPI assigned

Aug 10, 2005

Last updated

Jun 26, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Dr. Geraldine Marie Gadomski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Tiffany Zimmerman DC PC

  • Chiropractor
  • Moline, IL
  • NPI 1306085428
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1225039324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 5TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657911",
            "telephone_number": "309-764-9255",
            "fax_number": "309-762-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 5TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657911",
            "telephone_number": "309-764-9255",
            "fax_number": "309-762-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUCKENBERG",
        "first_name": "GERALDINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038 007464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08132048",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA PUBLIC AID",
            "identifier": "1179978",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038 007464",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00174127",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GERALDINE",
            "last_name": "GADOMSKI",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Chiropractor in Moline, IL
• Providers in Moline, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.