Healthcare Provider Details

I. General information

NPI: 1043749559
Provider Name (Legal Business Name): TANNER KUTZLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 MAPLE GROVE RD
DULUTH MN
55811-1881
US

IV. Provider business mailing address

2524 MAPLE GROVE RD
DULUTH MN
55811-1881
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-1423
  • Fax: 218-722-1423
Mailing address:
  • Phone: 218-722-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6352
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: