Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 08003013A | IN |
Y | 111NN1001X | Nutrition | 08003013A | IN |
NPI | 1467950287 |
---|---|
Provider Name | Chloe Tillman |
First Address | Indianapolis, IN 46214-3926 |
Second Address | Indianapolis, IN 46214-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |