Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3790 | MN |
NPI | 1740346816 |
---|---|
Provider Name | Dr. Ted H Harrison SR. |
First Address | Spring Lake Park, MN 55432-1865 |
Second Address | Spring Lake Park, MN 55432-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 08/07/2007 |