Provider Demographics
NPI:1902228356
Name:CLARE, KATHLEEN (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CLARE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KJOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2746 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1644
Mailing Address - Country:US
Mailing Address - Phone:952-831-0242
Mailing Address - Fax:
Practice Address - Street 1:5250 W 74TH ST STE 8
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2229
Practice Address - Country:US
Practice Address - Phone:952-831-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5856111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor