Provider Demographics
NPI:1780760504
Name:CHMIELEWSKI, KIM (LAC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18975 EMBERS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8740
Mailing Address - Country:US
Mailing Address - Phone:651-460-3580
Mailing Address - Fax:
Practice Address - Street 1:670 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2755
Practice Address - Country:US
Practice Address - Phone:507-645-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist