Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2005 | MD |
NPI | 1023224631 |
---|---|
Provider Name | Dr. Alcides Hector Carrillo |
First Address | Gaithersburg, MD 20877-3093 |
Second Address | Gaithersburg, MD 20877-3093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11378431 | (02) | MD |