Healthcare Provider Details

I. General information

NPI: 1124026786
Provider Name (Legal Business Name): KEITH ALAN KUCH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 N RIVERFRONT DR SUITE 101
MANKATO MN
56001-3259
US

IV. Provider business mailing address

1704 N RIVERFRONT DR SUITE 101
MANKATO MN
56001-3259
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-1222
  • Fax: 507-387-2563
Mailing address:
  • Phone: 507-387-1222
  • Fax: 507-387-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2567
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: