Healthcare Provider Details

I. General information

NPI: 1679554828
Provider Name (Legal Business Name): KYLE M HAMS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EAST MAIN ST
HINCKLEY MN
55037-0543
US

IV. Provider business mailing address

PO BOX 543
HINCKLEY MN
55037-0543
US

V. Phone/Fax

Practice location:
  • Phone: 320-384-6790
  • Fax: 320-384-6836
Mailing address:
  • Phone: 320-384-6790
  • Fax: 320-384-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2321
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: