Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 970 | ND |
N | 111NR0400X | Rehabilitation Chiropractor | 970 | ND |
NPI | 1164833919 |
---|---|
Provider Name | Paul Pearson |
First Address | Minot, ND 58701-4912 |
Second Address | Minot, ND 58701-4912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 25/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
970 | CHIROPRACTIC ASSOCIATION (01) | ND |