Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4024 | MN |
NPI | 1811080989 |
---|---|
Provider Name | Ryan J Brandt |
First Address | Coon Rapids, MN 55448-3362 |
Second Address | Coon Rapids, MN 55448-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044N0BR | BLUECROSS BLUESHIELD (01) | MN |
U84096 | (02) | MN |