Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 6091 | OR |
NPI | 1558971481 |
---|---|
Provider Name | Christopher Gosselin |
First Address | Keizer, OR 97303-5349 |
Second Address | Keizer, OR 97303-5349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 05/08/2020 |