Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4255 | MN |
NPI | 1013019553 |
---|---|
Provider Name | Dr. Darrick A Dierkhising |
First Address | Saint Joseph, MN 56374-9813 |
Second Address | Stillwater, MN 55082-6056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07223 | (02) | MN |