Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 001968 | MN |
NPI | 1063510253 |
---|---|
Provider Name | Dr. Christopher Lee Sorenson |
First Address | Saint Cloud, MN 56303-1207 |
Second Address | Saint Cloud, MN 56303-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4420045 | CHIROCARE (01) | MN |
55419SO | BCBS (01) | MN |