Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2592 | MN |
NPI | 1003131608 |
---|---|
Provider Name | Warren D Hildreth |
First Address | Maple Grove, MN 55311-3023 |
Second Address | Maple Grove, MN 55311-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2010 |
Last Update Date | 07/04/2010 |