Provider Demographics
NPI:1912445917
Name:STITTLEBURG, KALAN CLETE (DC)
Entity Type:Individual
Prefix:DR
First Name:KALAN
Middle Name:CLETE
Last Name:STITTLEBURG
Suffix:
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 1:2300 SUPERIOR DR NW
Mailing Address - Street 2:STE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3062
Mailing Address - Country:US
Mailing Address - Phone:715-937-0549
Mailing Address - Fax:
Practice Address - Street 1:2300 SUPERIOR DR NW
Practice Address - Street 2:STE 2
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3062
Practice Address - Country:US
Practice Address - Phone:715-937-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor