Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC4112 | MN |
N | 111NN1001X | Nutrition | DC4112 | MN |
NPI | 1366547960 |
---|---|
Provider Name | Dr. John Scott Harrison |
First Address | Edina, MN 55439-3008 |
Second Address | Edina, MN 55435-1724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 25/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50D98IN | BCBS PROVIDER NUMBER (01) | MN |
50D99HA | MN PROVIDER NUMBER (01) | MN |