Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 003669 | MN |
NPI | 1043361314 |
---|---|
Provider Name | Dr. Patricia Michele Casello-Maddox |
First Address | Bloomington, MN 55431-2768 |
Second Address | Bloomington, MN 55431-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 07/03/2014 |