Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5981 | MN |
NPI | 1073918900 |
---|---|
Provider Name | Dr. Jordan Roby |
First Address | Minnetonka, MN 55345-2634 |
Second Address | Minnetonka, MN 55345-2634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |