Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 121206 | AK |
NPI | 1366969859 |
---|---|
Provider Name | Briana Dimond |
First Address | Anchorage, AK 99515-3534 |
Second Address | Anchorage, AK 99515-3534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2017 |
Last Update Date | 24/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
121206 | LMT (01) | AK |