Provider Demographics
NPI:1659750420
Name:HAGENBUCH, KELLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:HAGENBUCH
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:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:TAYLORS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55084-0237
Mailing Address - Country:US
Mailing Address - Phone:651-465-3811
Mailing Address - Fax:
Practice Address - Street 1:397 BENCH ST
Practice Address - Street 2:
Practice Address - City:TAYLORS FALLS
Practice Address - State:MN
Practice Address - Zip Code:55084-0237
Practice Address - Country:US
Practice Address - Phone:651-465-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor