Individual provider Active NPI

Emily Michele Kruse, D.C.

  • Chiropractor
  • Waterloo, IL
National Provider Identifier
1780067256
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.012833 Issued in IL
Practice address
208 E Mill St
Waterloo, IL 62298-1519
Phone
(618) 939-3009
NPI assigned
Jul 2, 2015
Last updated
Oct 21, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.012833 IL Primary

Addresses

Primary practice location

208 E Mill St
Waterloo, IL 62298-1519

Mailing address

208 E Mill St
Waterloo, IL 62298-1519
Phone (618) 939-3009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150813010067 IL Practitioner - Chiropractic 7618282179 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

208 E Mill St
Waterloo, IL 62298-1519
Phone (618) 410-2855

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.012833ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kruse Chiropractic, LLC Chiropractor CurrentSince Sep 5, 2015 Accepting new patients
KC Chiropractic LLC Chiropractor CurrentSince Feb 12, 2023 Accepting new patients
Darding Chiropractic, P.C. Chiropractor CurrentSince Jul 27, 2015 Accepting new patients

Locations

1327 Jamie Ln
Waterloo, IL 62298
Phone (618) 939-9969

208 E Mill St
Waterloo, IL 62298
Phone (618) 406-1342

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": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445385600000",
    "number": "1780067256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 E MILL ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981519",
            "telephone_number": "618-939-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E MILL ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981519",
            "telephone_number": "618-939-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "EMILY",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; 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.