Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3064 | MN |
NPI | 1699846543 |
---|---|
Provider Name | Dr. Lawrence Moritko |
First Address | Blaine, MN 55434-7602 |
Second Address | Fridley, MN 55432-4322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 02/03/2019 |