Provider Demographics
NPI:1063596344
Name:KISNER, TERRY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ANN
Last Name:KISNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DIVISION ST.
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358
Mailing Address - Country:US
Mailing Address - Phone:320-963-6003
Mailing Address - Fax:320-963-7003
Practice Address - Street 1:121 DIVISION ST.
Practice Address - Street 2:
Practice Address - City:MAPLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55358
Practice Address - Country:US
Practice Address - Phone:320-963-6003
Practice Address - Fax:320-963-7003
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor