Provider Demographics
NPI:1447266697
Name:KRUMME, ELLEN BUERGER (DC)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BUERGER
Last Name:KRUMME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 GATEWAY
Mailing Address - Street 2:SUITE103
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1897
Mailing Address - Country:US
Mailing Address - Phone:513-204-0050
Mailing Address - Fax:513-204-7960
Practice Address - Street 1:5770 GATEWAY
Practice Address - Street 2:SUITE103
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1897
Practice Address - Country:US
Practice Address - Phone:513-204-0050
Practice Address - Fax:513-204-7960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311500239026OtherCARE SOURCE
OHUNITED HEATHCAREOther311500239
OH0173128Medicaid
OHANTHEM BCBSOther000000380597
OHKR0770463Medicare ID - Type UnspecifiedMEDICARE