Healthcare Provider Details

I. General information

NPI: 1497937882
Provider Name (Legal Business Name): NATHAN KADLEC DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 TH HWY 12
IPSWICH SD
57451-0314
US

IV. Provider business mailing address

PO BOX 314
IPSWICH SD
57451-0314
US

V. Phone/Fax

Practice location:
  • Phone: 605-426-6063
  • Fax: 605-426-6304
Mailing address:
  • Phone: 605-426-6063
  • Fax: 605-426-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1124
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: