Provider Demographics
NPI:1245620764
Name:VRUWINK, KELLY RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RENEE
Last Name:VRUWINK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 RANDOLPH AVE
Mailing Address - Street 2:#2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1334
Mailing Address - Country:US
Mailing Address - Phone:507-269-9577
Mailing Address - Fax:
Practice Address - Street 1:2083 RANDOLPH AVE
Practice Address - Street 2:#2
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1334
Practice Address - Country:US
Practice Address - Phone:507-269-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor