Provider Demographics
NPI:1194264929
Name:MELANDER CRIMMINS, KEVIN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:MELANDER CRIMMINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15678 PILOT KNOB RD STE 120
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7211
Mailing Address - Country:US
Mailing Address - Phone:651-456-8744
Mailing Address - Fax:320-295-7398
Practice Address - Street 1:15678 PILOT KNOB RD STE 120
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7211
Practice Address - Country:US
Practice Address - Phone:651-456-8744
Practice Address - Fax:320-295-7398
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor