Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5891 | AZ |
NPI | 1366473639 |
---|---|
Provider Name | Arlen Earle Scholl |
First Address | Phoenix, AZ 85018-5156 |
Second Address | Phoenix, AZ 85018-5156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U73913 | (02) | AZ |