Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-03403 | KS |
NPI | 1003853896 |
---|---|
Provider Name | David C Bumgarner |
First Address | Coffeyville, KS 67337-4814 |
Second Address | Coffeyville, KS 67337-4814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T43810 | (02) |