Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4078 | WI |
Y | 111NP0017X | Pediatric Chiropractor | 4414 | MN |
NPI | 1538257548 |
---|---|
Provider Name | Dr. Felicia Marie Conner |
First Address | Bloomington, MN 55431-1504 |
Second Address | Bloomington, MN 55431-1504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38956900 | (05) | WI |
C05326 | (02) | MN |
V03683 | (02) | WI |