Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4077 | MN |
NPI | 1255528931 |
---|---|
Provider Name | Dr. Brendn John O'brien |
First Address | Minneapolis, MN 55401-1292 |
Second Address | Minneapolis, MN 55401-1292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |