Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1915 | MN |
NPI | 1285716993 |
---|---|
Provider Name | Dr. Terence L. Drassal |
First Address | Shoreview, MN 55126-8069 |
Second Address | Shoreview, MN 55126-8069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-37462 | (02) | MN |