Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3512 | MN |
NPI | 1003937640 |
---|---|
Provider Name | Dr. Chad Alan Eiswald |
First Address | Arden Hills, MN 55112-3756 |
Second Address | Shoreview, MN 55126-8069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U-76775 | (02) | MN |