Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00528900 | NJ |
N | 111NI0013X | Independent Medical Examiner | 38MC00528900 | NJ |
N | 111NR0400X | Rehabilitation Chiropractor | 38MC00528900 | NJ |
NPI | 1043544703 |
---|---|
Provider Name | Dr. Auguste Duverneau |
First Address | Englewood, NJ 07631-2463 |
Second Address | Englewood, NJ 07631-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 29/09/2009 |