Provider Demographics
NPI:1730202557
Name:KRULL, KIM (LAC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:KRULL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 S DICKINSON DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-3031
Mailing Address - Country:US
Mailing Address - Phone:509-927-8097
Mailing Address - Fax:
Practice Address - Street 1:508 W 6TH AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2770
Practice Address - Country:US
Practice Address - Phone:509-747-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist