Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2535 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 2813 | MN |
NPI | 1164580031 |
---|---|
Provider Name | David Mark Washa |
First Address | Lacrosse, WI 54601 |
Second Address | Lacrosse, WI 54601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000070231 | (02) | WI |
279J7WA | BLUE CROSS BLUE SHIELD (01) | MN |
391762498 | (02) | |
391762498 | FED TAX (01) | WI |
391762498015 | BLUE CROSS BLUE SHIELD (01) | WI |
P00046865 | RAILROAD MEDICARE (01) |