Healthcare Provider Details

I. General information

NPI: 1659946895
Provider Name (Legal Business Name): KAYLENE MYA HUTCHINGS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 MAIN ST STE 102
NORTH BRANCH MN
55056-5139
US

IV. Provider business mailing address

6241 MAIN ST STE 102
NORTH BRANCH MN
55056-5139
US

V. Phone/Fax

Practice location:
  • Phone: 651-470-5422
  • Fax:
Mailing address:
  • Phone: 651-470-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6837
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: