Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2438 | AL |
N | 111NR0400X | Rehabilitation Chiropractor | 2438 | AL |
NPI | 1245634567 |
---|---|
Provider Name | Dr. Brian Mann |
First Address | Madison, AL 35758-7719 |
Second Address | Madison, AL 35758-7719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 15/10/2014 |