Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 6471 | MN |
NPI | 1265930325 |
---|---|
Provider Name | Katie Larson |
First Address | Cloquet, MN 55720-1563 |
Second Address | Cloquet, MN 55720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 01/11/2019 |