Provider Demographics
NPI:1881902591
Name:DR. KIM LEIS-KEELING, LLC
Entity type:Organization
Organization Name:DR. KIM LEIS-KEELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEIS-KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-834-2779
Mailing Address - Street 1:1770 SWITCHGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8533
Mailing Address - Country:US
Mailing Address - Phone:612-834-2779
Mailing Address - Fax:
Practice Address - Street 1:2121 CLIFF DR STE 101
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3407
Practice Address - Country:US
Practice Address - Phone:612-834-2779
Practice Address - Fax:654-330-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4498111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty