Healthcare Provider Details

I. General information

NPI: 1225066822
Provider Name (Legal Business Name): KELVIN K SALATHE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CONEY ST W
PERHAM MN
56573-2117
US

IV. Provider business mailing address

101 CONEY ST W
PERHAM MN
56573-2117
US

V. Phone/Fax

Practice location:
  • Phone: 218-346-2225
  • Fax: 218-346-5128
Mailing address:
  • Phone: 218-346-2225
  • Fax: 218-346-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2807
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: