Provider Demographics
NPI:1184382814
Name:KITTOCK, MAUREN LYNN (DC)
Entity type:Individual
Prefix:
First Name:MAUREN
Middle Name:LYNN
Last Name:KITTOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MAUREN
Other - Middle Name:LYNN
Other - Last Name:THIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:327 13TH ST S STE 110
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-4641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:327 13TH ST S STE 110
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-4641
Practice Address - Country:US
Practice Address - Phone:763-972-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor