Healthcare Provider Details

I. General information

NPI: 1194990606
Provider Name (Legal Business Name): KASTNER CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SOUTH CENTRAL AVENUE
ELBOW LAKE MN
56531
US

IV. Provider business mailing address

PO BOX 145
ELBOW LAKE MN
56531
US

V. Phone/Fax

Practice location:
  • Phone: 218-685-4544
  • Fax:
Mailing address:
  • Phone: 218-685-4544
  • Fax: 218-685-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOSEPH KASTNER
Title or Position: OWNER
Credential: DC
Phone: 218-685-4544