MEDICARE: KEVIN M QUAAS INC

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	3314	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952479651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN M QUAAS INC

Provider Business Mailing Address
First Line	:	4651 WHITE BEAR PKWY
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3300
Country	:	US
Telephone Number	:	651-426-5459
Fax Number	:	651-429-2420

Provider Business Practice Location Address
First Line	:	4651 WHITE BEAR PKWY
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3300
Country	:	US
Telephone Number	:	651-426-5459
Fax Number	:	651-429-2420

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN MATTHEW QUAAS
Credential	:	DC
Telephone Number	:	651-426-5459

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/10/2024

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