Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3234 | MN |
NPI | 1013012913 |
---|---|
Provider Name | Michelle Marie Greenman |
First Address | Crystal, MN 55428-3556 |
Second Address | Crystal, MN 55428-3556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4C416HU | BLUE CROSS BLUE SHIELD (01) | MN |
648692 | ACN (01) | MN |