MEDICARE: DR. ELISA MARIE KENSINGER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5077	MN

General Provider Information

NPI Number	:	1477723492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISA MARIE KENSINGER DC

Provider Business Mailing Address
First Line	:	2424 E 117TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1269
Country	:	US
Telephone Number	:	952-894-5108
Fax Number	:	952-890-5950

Provider Business Practice Location Address
First Line	:	2424 E 117TH ST
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1269
Country	:	US
Telephone Number	:	952-894-5108
Fax Number	:	952-890-5950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	08/04/2010

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