Healthcare Provider Details

I. General information

NPI: 1548260524
Provider Name (Legal Business Name): KEVIN L UTECH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 WEST ST S STE 300
GRINNELL IA
50112-8103
US

IV. Provider business mailing address

629 WEST ST S SUITE 300
GRINNELL IA
50112-8103
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-8000
  • Fax: 641-236-8001
Mailing address:
  • Phone: 641-236-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06792
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: