Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5912 | MN |
NPI | 1083033658 |
---|---|
Provider Name | Dr. Thomas David Ronning |
First Address | Long Lake, MN 55356-9491 |
Second Address | Long Lake, MN 55356-9491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 10/04/2014 |