Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5928 | MN |
N | 111NN0400X | Neurology | 5928 | MN |
NPI | 1528478336 |
---|---|
Provider Name | Dr. Michael Patrick Hennes |
First Address | Burnsville, MN 55306-5700 |
Second Address | Burnsville, MN 55306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 03/06/2020 |