Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 0000000000000000 | MN |
NPI | 1639628902 |
---|---|
Provider Name | Mrs. Kathie Kay Hixon-Smith |
First Address | Roseville, MN 55113-6514 |
Second Address | Roseville, MN 55113-6514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2016 |
Last Update Date | 28/09/2016 |