Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 4 | WV |
Y | 213ES0000X | Sports Medicine | 4 | WV |
NPI | 1366900532 |
---|---|
Provider Name | Caisie Adcock |
First Address | Given, WV 25245-8067 |
Second Address | Given, WV 25245-8067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45764787987 | (05) | WV |