Individual
JOHN WAYNE SAMUELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
13 W 2ND AVE N, AURORA, MN 55705-1313
(218) 229-3638
(218) 229-2661
Mailing address
13 W 2ND AVE N, AURORA, MN 55705-1313
(218) 229-3638
(218) 229-2661
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
1626
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230743
CHIROCARE
MN
01
—
69716SA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/25/2006
Last updated
07/09/2007
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