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General NPI Number Information
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NPI Number | 1922283118
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Entity Type | Organization
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Legal Business Name | KADLEC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 615 TH HWY 12
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City | IPSWICH
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State | SD
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Zip | 57451-0314
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Country | US
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Telephone | 605-426-6063
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Fax | 605-426-6304
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | IPSWICH
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State | SD
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Zip | 57451-0314
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Country | US
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Telephone | 605-426-6063
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Fax | 605-426-6304
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. NATHAN KADLEC
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Credential | D.C.
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Telephone | 605-426-6063
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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 | 1124
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License Number State | SD
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