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General NPI Number Information
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NPI Number | 1881902591
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Entity Type | Organization
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Legal Business Name | DR. KIM LEIS-KEELING, LLC
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 2121 CLIFF DR STE 101
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City | EAGAN
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State | MN
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Zip | 55122-3407
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Country | US
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Telephone | 612-834-2779
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Fax | 654-330-3901
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Provider Business Mailing Address
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Address Line | 1770 SWITCHGRASS CIR
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City | SHAKOPEE
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State | MN
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Zip | 55379-8533
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Country | US
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Telephone | 612-834-2779
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. KIM M. LEIS-KEELING
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Credential | DC
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Telephone | 612-834-2779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 4498
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License Number State | MN
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