Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR008734 | GA |
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR008734 | GA |
NPI | 1366743171 |
---|---|
Provider Name | Dr. Benedict V Cavaliere JR. |
First Address | Canton, GA 30114-8614 |
Second Address | Canton, GA 30114-8614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |