Provider Demographics
NPI:1831313980
Name:LAND., IAN R (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:R
Last Name:LAND.
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14247 O'CONNELL COURT - #275
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-226-5502
Mailing Address - Fax:952-226-5504
Practice Address - Street 1:14247 O'CONNELL COURT #275
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-226-5502
Practice Address - Fax:952-226-5504
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3613111N00000X
MNMN3613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4410386-00Medicaid
98-44573Medicare ID - Type Unspecified