Provider Demographics
NPI:1477732261
Name:HUELSKAMP CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:HUELSKAMP CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:HUELSKAMP
Authorized Official - Last Name:HUELSKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-533-8011
Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1661
Mailing Address - Country:US
Mailing Address - Phone:507-533-8011
Mailing Address - Fax:507-533-8011
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1661
Practice Address - Country:US
Practice Address - Phone:507-533-8011
Practice Address - Fax:507-533-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU39136Medicare UPIN