Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | SC |
NPI | 1730461138 |
---|---|
Provider Name | Chad N Mullins |
First Address | Great Falls, SC 29055-1219 |
Second Address | Great Falls, SC 29055-1219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 13/09/2011 |