Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 004785 | NY |
NPI | 1205825627 |
---|---|
Provider Name | Dr. Brett Riley Tallents |
First Address | Fulton, NY 13069-1844 |
Second Address | Fulton, NY 13069-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26759 | (02) | NY |