Healthcare Provider Details

I. General information

NPI: 1841742764
Provider Name (Legal Business Name): KEVIN HUGGENBERGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 16TH ST
BERESFORD SD
57004-1503
US

IV. Provider business mailing address

504 N 16TH ST
BERESFORD SD
57004-1503
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-8056
  • Fax: 605-763-8057
Mailing address:
  • Phone: 605-763-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number084587
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1347
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: