Provider Demographics
NPI:1285905760
Name:DEVRIES, KATHRYN JO (DC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JO
Last Name:DEVRIES
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 1:6041 MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6588
Mailing Address - Country:US
Mailing Address - Phone:763-232-0326
Mailing Address - Fax:
Practice Address - Street 1:6041 MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6588
Practice Address - Country:US
Practice Address - Phone:763-232-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor