Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1742 | MN |
NPI | 1285898767 |
---|---|
Provider Name | Jeffrey Allen Ewald |
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 | 15/07/2008 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
812727100 | (05) | MN |
T84946 | (02) | MN |