Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X007098-1 | NY |
NPI | 1003020819 |
---|---|
Provider Name | Beth A John |
First Address | West Babylon, NY 11704-6634 |
Second Address | West Babylon, NY 11704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 03/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CO-X007098-9 | WORKMANS COMPENSATION (01) | NY |