Provider Demographics
NPI:1902389687
Name:CARDER, KENT ELLIS II (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ELLIS
Last Name:CARDER
Suffix:II
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 1:20176 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6855
Mailing Address - Country:US
Mailing Address - Phone:612-462-0402
Mailing Address - Fax:
Practice Address - Street 1:20176 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6855
Practice Address - Country:US
Practice Address - Phone:952-985-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor