Provider Demographics
NPI:1871529404
Name:VENERUS, KEVIN M (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:VENERUS
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 1:2901 DORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1837
Mailing Address - Country:US
Mailing Address - Phone:612-618-6571
Mailing Address - Fax:
Practice Address - Street 1:2901 DORMAN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1837
Practice Address - Country:US
Practice Address - Phone:612-618-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008605111N00000X
MN6176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881779031OtherABS INC NPI #
MI144951428Medicaid
MIP38210Medicare UPIN
MI0H22911OtherBCBS PIN