Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3195 | AZ |
NPI | 1528336690 |
---|---|
Provider Name | Dr. Bruce E. Staggs |
First Address | Tucson, AZ 85747-4708 |
Second Address | Tucson, AZ 87547-4708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2011 |
Last Update Date | 05/12/2011 |