Provider Demographics
NPI:1306993183
Name:SWANSON-BUFFIE, KIMBERLY (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SWANSON-BUFFIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BUFFIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-0207
Mailing Address - Country:US
Mailing Address - Phone:763-477-4266
Mailing Address - Fax:763-477-6228
Practice Address - Street 1:8340 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9578
Practice Address - Country:US
Practice Address - Phone:763-477-4266
Practice Address - Fax:763-477-6228
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN407028300Medicaid
MN350003140Medicare ID - Type Unspecified
MN407028300Medicaid