Healthcare Provider Details

I. General information

NPI: 1063727733
Provider Name (Legal Business Name): BENJAMIN ROBERT KINDERMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 3RD ST NW
ELK RIVER MN
55330-1445
US

IV. Provider business mailing address

2217 VINE ST STE 102
HUDSON WI
54016-5864
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4800
  • Fax: 763-587-4885
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4652-12
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5422
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: