Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH12629 | FL |
NPI | 1003400953 |
---|---|
Provider Name | Ben Zedler |
First Address | South Miami, FL 33143-3654 |
Second Address | South Miami, FL 33143-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2021 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003400953 | CHIROPRACTIC (01) | FL |
CH12627 | CH12627 (01) | FL |