Healthcare Provider Details

I. General information

NPI: 1275553737
Provider Name (Legal Business Name): LA CRESCENT CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 MAIN ST SUITE 1
LA CRESCENT MN
55947-1828
US

IV. Provider business mailing address

306 MAIN ST SUITE 1
LA CRESCENT MN
55947-1828
US

V. Phone/Fax

Practice location:
  • Phone: 507-895-6015
  • Fax: 507-895-6345
Mailing address:
  • Phone: 507-895-6015
  • Fax: 507-895-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4226
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1575
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number138
License Number StateMN

VIII. Authorized Official

Name: ERIC J KIESAU
Title or Position: PRESIDENT
Credential: D.C.
Phone: 507-895-6015