Provider Demographics
NPI:1790726727
Name:HUELSKAMP, KEVIN WILLIAM (DC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:HUELSKAMP
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 1:120 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976
Mailing Address - Country:US
Mailing Address - Phone:507-533-8011
Mailing Address - Fax:507-533-8771
Practice Address - Street 1:120 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976
Practice Address - Country:US
Practice Address - Phone:507-533-8011
Practice Address - Fax:507-533-8771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C818HUOtherBCBS
U39136Medicare UPIN