Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5531 | MN |
N | 111NN0400X | Neurology | 5531 | MN |
NPI | 1164714523 |
---|---|
Provider Name | Dr. Jeremiah Ryan Schmoe |
First Address | Minnetonka, MN 55305-1772 |
Second Address | Minnetonka, MN 55305-1772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 12/12/2017 |