Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1066 | AR |
NPI | 1497740179 |
---|---|
Provider Name | Dr. Anthony Iwan Doncheff |
First Address | Ash Flat, AR 72513-9594 |
Second Address | Ash Flat, AR 72513-9594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 14/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180489718 | (05) | AR |
59009 | MEDICARE ID (01) | AR |
T20514 | (02) | AR |