Provider Demographics
NPI:1225066822
Name:SALATHE, KELVIN K (DC)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:K
Last Name:SALATHE
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 1:101 CONEY ST W
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-2117
Mailing Address - Country:US
Mailing Address - Phone:218-346-2225
Mailing Address - Fax:218-346-5128
Practice Address - Street 1:101 CONEY ST W
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-2117
Practice Address - Country:US
Practice Address - Phone:218-346-2225
Practice Address - Fax:218-346-5128
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN404228000Medicaid
MNU16983Medicare UPIN
MN404228000Medicaid
MN350001630Medicare PIN
MN350001630Medicare ID - Type UnspecifiedPROVIDER ID