Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-001169-L | PA |
N | 111NT0100X | Thermography | 001169L | PA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 001169L | PA |
NPI | 1538211636 |
---|---|
Provider Name | Constance D Haber |
First Address | Monroeville, PA 15146-3576 |
Second Address | Monroeville, PA 15146-3576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 17/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00631206 | (05) | PA |
T28817 | (02) | PA |