Provider Demographics
NPI:1720282296
Name:KES CHIROPRACTIC, PA
Entity type:Organization
Organization Name:KES CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-447-0985
Mailing Address - Street 1:14033 COMMERCE AVE NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1438
Mailing Address - Country:US
Mailing Address - Phone:952-447-0985
Mailing Address - Fax:952-447-0986
Practice Address - Street 1:14033 COMMERCE AVE NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1438
Practice Address - Country:US
Practice Address - Phone:952-447-0985
Practice Address - Fax:952-447-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4251-12111N00000X
MN4240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU91968Medicare UPIN