Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 14781 | TX |
NPI | 1265004162 |
---|---|
Provider Name | Angelica Patton |
First Address | College Station, TX 77845 |
Second Address | College Station, TX 77845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |