Provider Demographics
NPI:1275625030
Name:IVERSON, KENN E (DC PC)
Entity Type:Individual
Prefix:DR
First Name:KENN
Middle Name:E
Last Name:IVERSON
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 2ND AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4177
Mailing Address - Country:US
Mailing Address - Phone:701-252-2424
Mailing Address - Fax:701-252-3205
Practice Address - Street 1:312 2ND AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4177
Practice Address - Country:US
Practice Address - Phone:701-252-2424
Practice Address - Fax:701-252-3205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25654OtherBLUE CROSS OF NORTH DAKOT
ND12894Medicaid
ND25654OtherBLUE CROSS OF NORTH DAKOT
NDN711403Medicare PIN