Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 20-8399311 | MN |
NPI | 1023568086 |
---|---|
Provider Name | John Hoang |
First Address | Spring Lake Park, MN 55432-2124 |
Second Address | Spring Lake Park, MN 55432-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 13/10/2016 |