Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 7308 | AZ |
NPI | 1366618175 |
---|---|
Provider Name | Dr. Benny Edward Nixon II |
First Address | Phoenix, AZ 85085-2848 |
Second Address | Phoenix, AZ 85085-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 17/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7308 | CHIROPRACTIC LICENSE # (01) | AZ |