Provider Demographics
NPI:1881324994
Name:SIEGFORD, KENNETH L (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:SIEGFORD
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38400 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-2191
Mailing Address - Country:US
Mailing Address - Phone:218-670-0599
Mailing Address - Fax:
Practice Address - Street 1:601 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1864
Practice Address - Country:US
Practice Address - Phone:218-670-0599
Practice Address - Fax:218-216-8986
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist