Healthcare Provider Details

I. General information

NPI: 1922694033
Provider Name (Legal Business Name): KYLE HOVE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W MAIN ST
WACONIA MN
55387-1020
US

IV. Provider business mailing address

20 W MAIN ST
WACONIA MN
55387-1020
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-9876
  • Fax:
Mailing address:
  • Phone: 952-442-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6764
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: