Healthcare Provider Details

I. General information

NPI: 1477732261
Provider Name (Legal Business Name): HUELSKAMP CHIROPRACTIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST
STEWARTVILLE MN
55976-1661
US

IV. Provider business mailing address

120 S MAIN ST
STEWARTVILLE MN
55976-1661
US

V. Phone/Fax

Practice location:
  • Phone: 507-533-8011
  • Fax: 507-533-8011
Mailing address:
  • Phone: 507-533-8011
  • Fax: 507-533-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3045
License Number StateMN

VIII. Authorized Official

Name: DR. KEVIN HUELSKAMP HUELSKAMP
Title or Position: PRESIDENT
Credential: D.C.
Phone: 507-533-8011