Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4397 | MN |
NPI | 1003962440 |
---|---|
Provider Name | Dr. Andrew Jon Linn |
First Address | Zimmerman, MN 55398-0377 |
Second Address | Zimmerman, MN 55398-9305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 12/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1DD42LI | BLUE CROSS BLUE SHIELD (01) | MN |
809603100 | (05) | MN |
U95108 | (02) | MN |