Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH 60345251 | WA |
Y | 111NS0005X | Chiropractic Sports Physician | CH60345251 | WA |
NPI | 1255779716 |
---|---|
Provider Name | Dr. Andrew Michael Newman |
First Address | Bonney Lake, WA 98391-6917 |
Second Address | Bonney Lake, WA 98391-6917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 13/01/2020 |