Provider Demographics
NPI:1548697667
Name:KRUKOWSKI, KEITH (DC, CNIM)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:KRUKOWSKI
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WATERVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1472
Mailing Address - Country:US
Mailing Address - Phone:817-205-1321
Mailing Address - Fax:
Practice Address - Street 1:10221 CRAWFORD FARMS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8566
Practice Address - Country:US
Practice Address - Phone:817-205-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic