Provider Demographics
NPI:1598899072
Name:UNTERRIENER, KEVIN JOESPH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOESPH
Last Name:UNTERRIENER
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 1:9336 ENSIGN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1455
Mailing Address - Country:US
Mailing Address - Phone:952-829-0100
Mailing Address - Fax:952-942-6295
Practice Address - Street 1:9336 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1455
Practice Address - Country:US
Practice Address - Phone:952-829-0100
Practice Address - Fax:952-942-6295
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor