Provider Demographics
NPI:1215169842
Name:KANNAS, ANDREA KRISTEN (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:KRISTEN
Last Name:KANNAS
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 1:10 N 1ST AVE E STE 101
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1476
Mailing Address - Country:US
Mailing Address - Phone:218-290-4644
Mailing Address - Fax:
Practice Address - Street 1:10 N 1ST AVE E STE 101
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1476
Practice Address - Country:US
Practice Address - Phone:218-290-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6777111N00000X
VT006.0073893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor