Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3402 | MN |
N | 111NR0200X | Radiology | 3402 | MN |
N | 213ER0200X | Radiology | 3402 | MN |
NPI | 1619051059 |
---|---|
Provider Name | Jeffrey Alan Rich |
First Address | Bloomington, MN 55431-1602 |
Second Address | Bloomington, MN 55431-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U83503 | (02) | MN |