Provider Demographics
NPI:1841742764
Name:HUGGENBERGER, KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HUGGENBERGER
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 1:504 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1503
Mailing Address - Country:US
Mailing Address - Phone:605-763-8056
Mailing Address - Fax:
Practice Address - Street 1:504 N 16TH ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1503
Practice Address - Country:US
Practice Address - Phone:605-763-8056
Practice Address - Fax:605-763-8057
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084587111N00000X
SD1347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor