Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4719 | MN |
N | 111NI0013X | Independent Medical Examiner | 871 | MN |
NPI | 1629019195 |
---|---|
Provider Name | Dr. Brian Scott Garrity |
First Address | West St Paul, MN 55118-3421 |
Second Address | West St Paul, MN 55118-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V09545 | (02) | MN |