Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1812 | MN |
NPI | 1275619397 |
---|---|
Provider Name | Dr. John Ryan Michaels |
First Address | Hibbing, MN 55746-1548 |
Second Address | Hibbing, MN 55746-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3C955MI | BLUE CROSS BLUE SHIELD (01) | MN |
T65508 | (02) | MN |