Provider Demographics
NPI:1922598663
Name:HILL, LARA MAIJA
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:MAIJA
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SUPERIOR ST
Mailing Address - Street 2:STE 412
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-5025
Mailing Address - Country:US
Mailing Address - Phone:612-919-2662
Mailing Address - Fax:
Practice Address - Street 1:306 W SUPERIOR ST
Practice Address - Street 2:STE 412
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-5025
Practice Address - Country:US
Practice Address - Phone:612-919-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor