Healthcare Provider Details

I. General information

NPI: 1164574752
Provider Name (Legal Business Name): KENT CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 PRIOR AVE N
SAINT PAUL MN
55104-5163
US

IV. Provider business mailing address

245 PRIOR AVE N
SAINT PAUL MN
55104-5163
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-9110
  • Fax: 888-503-7553
Mailing address:
  • Phone: 651-696-9110
  • Fax: 888-503-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2722
License Number StateMN

VIII. Authorized Official

Name: SUSAN MARIE KENT
Title or Position: OWNER
Credential: D.C.
Phone: 651-696-9110