Individual
DR. BRIAN RICHARD CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7771 LAKE DR, LINO LAKES, MN 55014-1100
(651) 784-2225
(651) 784-2070
Mailing address
7771 LAKE DR, LINO LAKES, MN 55014-1100
(651) 784-2225
(651) 784-2070
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3324
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
377S4LA
BCBS CLINIC #
MN
01
—
38-3661239
FEDERAL TAX ID #
MN
Enumeration date
04/03/2007
Last updated
07/09/2007
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