Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4872 | MN |
NPI | 1659341840 |
---|---|
Provider Name | Dr. Susan Laurie Herda |
First Address | Maple Plain, MN 55359-8729 |
Second Address | Maple Plain, MN 55359-8729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 20/08/2020 |