Provider Demographics
NPI:1447374616
Name:KRUTHAUP, KEITH LLOYD (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:LLOYD
Last Name:KRUTHAUP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40585 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5724
Mailing Address - Country:US
Mailing Address - Phone:951-698-2511
Mailing Address - Fax:
Practice Address - Street 1:40585 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE F-2
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5724
Practice Address - Country:US
Practice Address - Phone:951-698-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0195070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor