Provider Demographics
NPI:1477613628
Name:BLOMKER, KANDIS KAY (DC)
Entity Type:Individual
Prefix:
First Name:KANDIS
Middle Name:KAY
Last Name:BLOMKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13276 HWY 55
Mailing Address - Street 2:
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389
Mailing Address - Country:US
Mailing Address - Phone:320-453-2311
Mailing Address - Fax:320-453-2311
Practice Address - Street 1:342 STATE ST. NO.
Practice Address - Street 2:
Practice Address - City:EDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55329
Practice Address - Country:US
Practice Address - Phone:320-453-2311
Practice Address - Fax:320-453-2311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN443122Medicare UPIN