Provider Demographics
NPI:1003157769
Name:KINETIC CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:KINETIC CHIROPRACTIC, P.C.
Other - Org Name:KINETIC SPINE & SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-345-7836
Mailing Address - Street 1:1219 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4329
Mailing Address - Country:US
Mailing Address - Phone:507-345-7836
Mailing Address - Fax:507-345-7835
Practice Address - Street 1:1219 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4329
Practice Address - Country:US
Practice Address - Phone:507-345-7836
Practice Address - Fax:507-345-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty