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General NPI Number Information
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NPI Number | 1003883034
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Entity Type | Individual
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Provider Name | CRAIG ROY KADDATZ DC
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 130 1ST STREET W #108
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City | CANBY
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State | MN
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Zip | 56220-1145
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Country | US
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Telephone | 507-233-7366
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Fax | 507-223-7366
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Provider Business Mailing Address
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Address Line | 130 1ST STREET W #108
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City | CANBY
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State | MN
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Zip | 56220-1145
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Country | US
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Telephone | 507-223-7366
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Fax | 507-223-7366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2538
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License Number State | MN
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