Provider Demographics
NPI:1063949998
Name:KOLTES, BRIAN S (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:KOLTES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 COLLEGE AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-9801
Mailing Address - Country:US
Mailing Address - Phone:320-363-4573
Mailing Address - Fax:320-363-1314
Practice Address - Street 1:103 COLLEGE AVE N
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374
Practice Address - Country:US
Practice Address - Phone:320-363-4573
Practice Address - Fax:320-363-1314
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty