MEDICARE: DR. KATHLEEN MARIE VIRGA D.C.

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	2700	MN

General Provider Information

NPI Number	:	1881780732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MARIE VIRGA D.C.

Provider Business Mailing Address
First Line	:	12670 LAKE BLVD
Second Line	:	PO BOX 482
City	:	LINDSTROM
State	:	MN
Zip	:	55045
Country	:	US
Telephone Number	:	651-257-1000
Fax Number	:	651-257-1020

Provider Business Practice Location Address
First Line	:	12670 LAKE BLVD
Second Line	:
City	:	LINDSTROM
State	:	MN
Zip	:	55045
Country	:	US
Telephone Number	:	651-257-1000
Fax Number	:	651-257-1020

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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