Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6651 | TX |
NPI | 1013016799 |
---|---|
Provider Name | Dr. Audie D Coggins |
First Address | Alpine, TX 79830-3812 |
Second Address | Alpine, TX 79830-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U58636 | (02) | TX |