Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 533 | WY |
NPI | 1003956442 |
---|---|
Provider Name | Dr. Alan J. Davenport |
First Address | Rock Springs, WY 82901 |
Second Address | Rock Springs, WY 82901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |