Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1948 | MN |
NPI | 1285766352 |
---|---|
Provider Name | Larry Lee Estebo |
First Address | Falcon Heights, MN 55113-6316 |
Second Address | Falcon Heights, MN 55113-6316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |