Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1708 | MN |
NPI | 1730289521 |
---|---|
Provider Name | Dr. Gus Vernon Kaubisch JR. |
First Address | Walker, MN 56484-0852 |
Second Address | Walker, MN 56484-0852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U02790 | (02) |