Provider Demographics
NPI:1043027287
Name:KIRK, WESTIN JAIDE
Entity type:Individual
Prefix:
First Name:WESTIN
Middle Name:JAIDE
Last Name:KIRK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 PENN AVE S APT E249
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3644
Mailing Address - Country:US
Mailing Address - Phone:507-476-7345
Mailing Address - Fax:
Practice Address - Street 1:7620 PENN AVE S APT E249
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3644
Practice Address - Country:US
Practice Address - Phone:507-476-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor