Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 5196 | MN |
Y | 111N00000X | Chiropractor | DC010069 | PA |
NPI | 1003055989 |
---|---|
Provider Name | Dr. Brett Wayne Speer |
First Address | Ottertail, MN 56571 |
Second Address | Little Falls, MN 56345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 01/12/2010 |