Healthcare Provider Details

I. General information

NPI: 1457357782
Provider Name (Legal Business Name): KEITH RAYMOND KAMRATH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

125 MAIN ST S
HUTCHINSON MN
55350-2506
US

IV. Provider business mailing address

125 MAIN ST S
HUTCHINSON MN
55350-2506
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-3888
  • Fax: 320-587-3888
Mailing address:
  • Phone: 320-587-3888
  • Fax: 320-587-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2062
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: