Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301007946 | MI |
NPI | 1003814195 |
---|---|
Provider Name | Carla Stratton |
First Address | Kalamazoo, MI 49009-2174 |
Second Address | Kalamazoo, MI 49009-2174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 27/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950C95051 | BCBSM PROVIDER NUMBER (01) | MI |
U77684 | (02) | MI |