Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1150 | AL |
NPI | 1174542625 |
---|---|
Provider Name | David Allen Head |
First Address | Sylacauga, AL 35150-2301 |
Second Address | Sylacauga, AL 35150-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68439 | (02) | AL |