| NPI | 1396986972 |
|---|---|
| Former Legal Business Name | BLACK AND BLUE BOXING, INC. |
| Entity Type | Organization |
| Authorized Contact | DANIEL EDWARD SANDELL Owner/Athletic Trainer 612-670-1565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2141) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2009-03-12 |