Provider Demographics
NPI:1548468093
Name:KAMPMEIER, VIRGINIA ROSE (DC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROSE
Last Name:KAMPMEIER
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 1:219 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1800
Mailing Address - Country:US
Mailing Address - Phone:651-493-0701
Mailing Address - Fax:
Practice Address - Street 1:219 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-1800
Practice Address - Country:US
Practice Address - Phone:651-493-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN692635000Medicaid
MN412D5KAOtherBCBS
MN350003929Medicare PIN