Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2609 | MN |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2609 | MN |
NPI | 1013093129 |
---|---|
Provider Name | Dr. Ryne D Devries |
First Address | Minneapolis, MN 55407-4311 |
Second Address | Minneapolis, MN 55407-4311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116055900 | (05) | MN |
T61766 | (02) | MN |