Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 893 | AL |
NPI | 1003957119 |
---|---|
Provider Name | Dr. Andy O Middleton |
First Address | Camp Hill, AL 36850-3710 |
Second Address | Camp Hill, AL 36850-3710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68507 | (02) | AL |