Provider Demographics
NPI:1194236950
Name:KRUEGER, DYLAN WEST (NMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:WEST
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 40TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3353
Mailing Address - Country:US
Mailing Address - Phone:602-368-9211
Mailing Address - Fax:480-878-6994
Practice Address - Street 1:16601 N 40TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3353
Practice Address - Country:US
Practice Address - Phone:602-368-9211
Practice Address - Fax:480-878-6994
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1675175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath