Provider Demographics
NPI:1205658598
Name:GROSETH, KALLAN C (DC)
Entity type:Individual
Prefix:DR
First Name:KALLAN
Middle Name:C
Last Name:GROSETH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KALLAN
Other - Middle Name:C
Other - Last Name:GROSETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1911 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2710
Mailing Address - Country:US
Mailing Address - Phone:605-275-5757
Mailing Address - Fax:
Practice Address - Street 1:1911 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2710
Practice Address - Country:US
Practice Address - Phone:605-275-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDPENDING111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor