Cody Lee Kruckenberg, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1333 Issued in SD

Practice address

312 E Holly Blvd
Brandon, SD 57005

Phone

(605) 254-7735

NPI assigned

Feb 3, 2015

Last updated

May 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2013

Medicare assignment

May accept Medicare assignment

Group practices

Fit for Life Chiropractic LLCGroup PAC ID 5698015428, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Fit for Life Chiropractic, LLC

  • Chiropractor
  • Brandon, SD
  • NPI 1740778422
  Medicare reassignment Care Compare group
• Modern Day Health Care Prof LLC

  • Multi-Specialty Clinic/Center
  • Aberdeen, SD
  • NPI 1851883540
  NPD
• Schoon Chiropractic PC

  • Chiropractor
  • Brandon, SD
  • NPI 1750425583
  NPD (past)

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1790175388",
    "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": "57005",
            "telephone_number": "605-254-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUCKENBERG",
        "first_name": "CODY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-03",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AK",
            "license": "600",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SD",
            "license": "1333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christi Kotzenmacher, RN
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• Matthew Krivarchka
• Lindsey Krueger, SW
• Jessica Landry, DPT
• Tesza Jo Larios, DOULA
• Luke Laycock, PT
• Lotus Bloom Counseling, LLC

• Chiropractor in Brandon, SD
• Providers in Brandon, SD by specialty
• Chiropractor in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.