Healthcare Provider Details

I. General information

NPI: 1861539777
Provider Name (Legal Business Name): KENWOOD MERLYN RUND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 HENNEPIN AVE
GLENCOE MN
55336-2206
US

IV. Provider business mailing address

1123 HENNEPIN AVE
GLENCOE MN
55336-2206
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-6249
  • Fax:
Mailing address:
  • Phone: 320-864-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1535
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: