Provider Demographics
NPI:1144461005
Name:KREPS CHIPRACTIC PC
Entity type:Organization
Organization Name:KREPS CHIPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KREPS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:218-236-1187
Mailing Address - Street 1:1675 CENTER AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1346
Mailing Address - Country:US
Mailing Address - Phone:218-236-1187
Mailing Address - Fax:218-236-8514
Practice Address - Street 1:1675 CENTER AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1346
Practice Address - Country:US
Practice Address - Phone:218-236-1187
Practice Address - Fax:218-236-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2116261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN359000663Medicare UPIN