Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 821 | WV |
NPI | 1396749784 |
---|---|
Provider Name | Anthony D Erwin |
First Address | Hurricane, WV 25526-8714 |
Second Address | Hurricane, WV 25526-9054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810004499 | (05) | WV |
V05781 | (02) | WV |