| NPI | 1891137220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID K KETROSER Owner 952-236-7610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MN 44760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3852) |
| 207X00000X Orthopaedic Surgery (Licence: MN 34220) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 24316) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 42871) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2014-06-17 |