Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | B02011 | NV |
N | 111N00000X | Chiropractor | DC 29177 | CA |
NPI | 1003842238 |
---|---|
Provider Name | Allen I-Han Su |
First Address | Las Vegas, NV 89146-8723 |
Second Address | Las Vegas, NV 89146-8723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 26/02/2015 |