Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1020 | ND |
NPI | 1003271784 |
---|---|
Provider Name | Blake Kerry Hochhalter |
First Address | Jamestown, ND 58401 |
Second Address | Jamestown, ND 58401-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 06/01/2016 |