Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1420 | MN |
NPI | 1205911294 |
---|---|
Provider Name | Dr. John David Reid |
First Address | Rochester, MN 55906-5403 |
Second Address | Rochester, MN 55906-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 07/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T70831 | (02) | MN |