Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1313 | MN |
NPI | 1225113368 |
---|---|
Provider Name | Dr. Dennis Alan Woggon |
First Address | Saint Cloud, MN 56303-4846 |
Second Address | Saint Cloud, MN 56303-4846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55549WO | BLUE CROSS/BLUE SHIELD (01) | MN |