Healthcare Provider Details

I. General information

NPI: 1235996877
Provider Name (Legal Business Name): MADILYN KAYSHA BLUNK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADILYN KAYSHA KESSEL

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 4TH AVE S
DENISON IA
51442-2427
US

IV. Provider business mailing address

909 4TH AVE S
DENISON IA
51442-2427
US

V. Phone/Fax

Practice location:
  • Phone: 712-263-4545
  • Fax:
Mailing address:
  • Phone: 712-269-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number125116
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: