1073550018 NPI number — MRS. KATIE MAE MURPHY DC

Table of content: MRS. KATIE MAE MURPHY DC (NPI 1073550018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073550018 NPI number — MRS. KATIE MAE MURPHY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURPHY
Provider First Name:
KATIE
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNECHTLY
Provider Other First Name:
KATIE
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073550018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10834 VINCENT AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-253-1381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 W 78TH ST
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
CHANHASSEN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-949-0676
Provider Business Practice Location Address Fax Number:
952-949-0868
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4727 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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