Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 275 | WV |
NPI | 1134207103 |
---|---|
Provider Name | Dr. Bruce Alan Dye |
First Address | Spencer, WV 25276-1314 |
Second Address | Spencer, WV 25276-1314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T32305 | (02) | WV |