NPIMap

Organization Active NPI

Fit for Life Chiropractic, LLC

  • Chiropractor
  • Brandon, SD
National Provider Identifier
1740778422
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
FIT FOR LIFE CHIROPRACTIC, LLC
Practice address
312 E Holly Blvd
Brandon, SD 57005-1240
Phone
(605) 254-7735
NPI assigned
Apr 27, 2018
Last updated
Apr 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Authorized official

Name
Tracey Lynne Kruckenberg, DCNPI 1811318470
Title
Owner/Chiropractor
Phone
(952) 250-4591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

312 E Holly Blvd
Brandon, SD 57005-1240

Mailing address

312 E Holly Blvd
Brandon, SD 57005-1240
Phone (605) 254-7735

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190314000737 SD Part B Supplier - Clinic/Group Practice 5698015428 Receives reassigned benefits from 2 practitioners
Practice locations: Brandon, SD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524787200000",
    "number": "1740778422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 E HOLLY BLVD",
            "city": "BRANDON",
            "state": "SD",
            "postal_code": "570051240",
            "telephone_number": "605-254-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 E HOLLY BLVD",
            "city": "BRANDON",
            "state": "SD",
            "postal_code": "570051240",
            "telephone_number": "605-254-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIT FOR LIFE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2018-04-27",
        "status": "A",
        "authorized_official_last_name": "KRUCKENBERG",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "952-250-4591",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.