Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4910 | MN |
NPI | 1003954348 |
---|---|
Provider Name | Rory Faherty |
First Address | Minneapolis, MN 55419-2045 |
Second Address | Excelsior, MN 55331-2925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |