Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6923 | MN |
NPI | 1003577198 |
---|---|
Provider Name | Blake Christopher Loxtercamp |
First Address | Lino Lakes, MN 55014-1402 |
Second Address | Dayton, MN 55327-7500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2022 |
Last Update Date | 01/01/2022 |