Healthcare Provider Details

I. General information

NPI: 1962720607
Provider Name (Legal Business Name): KATIE RAE LAYDEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 WELLNER DR NE SUITE C
ROCHESTER MN
55906-7329
US

IV. Provider business mailing address

3169 WELLNER DR NE SUITE C
ROCHESTER MN
55906-7329
US

V. Phone/Fax

Practice location:
  • Phone: 507-208-4305
  • Fax: 507-208-4307
Mailing address:
  • Phone: 507-208-4305
  • Fax: 507-208-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5369
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: