Provider Demographics
NPI:1194990606
Name:KASTNER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KASTNER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-685-4544
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531
Mailing Address - Country:US
Mailing Address - Phone:218-685-4544
Mailing Address - Fax:218-685-5140
Practice Address - Street 1:17 SOUTH CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531
Practice Address - Country:US
Practice Address - Phone:218-685-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62463KAOtherBCBS
MNC03016Medicare PIN