Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 22-166999-1202 | UT |
NPI | 1215979133 |
---|---|
Provider Name | Donald A. Cofer |
First Address | Park City, UT 84068-0638 |
Second Address | Park City, UT 84060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 31/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T98159 | (02) | UT |