Provider Demographics
NPI:1043483084
Name:KELZENBERG, PETER LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LEE
Last Name:KELZENBERG
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 1:220 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:763-425-5525
Mailing Address - Fax:763-425-6229
Practice Address - Street 1:220 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-425-5525
Practice Address - Fax:763-425-6229
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3440111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN604271OtherHEALTH PARTNERS
MN02D86OSOtherBCBS
MN44-40379OtherMEDICA
MN02D86OSOtherBCBS