Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4022 | MN |
N | 111NN0400X | Neurology | 4022 | MN |
NPI | 1740363795 |
---|---|
Provider Name | Dr. Amy Lynne Wiese Horton |
First Address | Bloomington, MN 55431-1602 |
Second Address | Bloomington, MN 55431-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U85667 | (02) | MN |