Provider Demographics
NPI:1679795751
Name:KLEPETKA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:KLEPETKA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KLEPETKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-762-2311
Mailing Address - Street 1:418 3RD AVE E., SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-762-2311
Mailing Address - Fax:
Practice Address - Street 1:418 3RD AVE E STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1574
Practice Address - Country:US
Practice Address - Phone:320-762-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C668KLOtherBCBS GROUP NUMBER
MN5C668KLOtherBCBS GROUP NUMBER