Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1809 | MN |
NPI | 1275614463 |
---|---|
Provider Name | Gregory Scott Ash |
First Address | Duluth, MN 55811-2742 |
Second Address | Duluth, MN 55802-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005227200 | (05) | MN |
99112154 | (05) | WI |
T65258 | (02) | MN |