Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 408 | MT |
NPI | 1467510222 |
---|---|
Provider Name | Lee Sanford Hudson |
First Address | Great Falls, MT 59405-4600 |
Second Address | Great Falls, MT 59405-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M000004085 | MEDICARE PTAN (01) | MT |