Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2079 | MN |
NPI | 1003956533 |
---|---|
Provider Name | Mary Clare Cooley |
First Address | Duluth, MN 55804-9661 |
Second Address | Duluth, MN 55804-9661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70913CO | BCBS (01) | MN |
T65422 | (02) |