Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X002610-1 | NY |
NPI | 1558453233 |
---|---|
Provider Name | Dr. Calvin Hargis |
First Address | Warwick, NY 10990-1025 |
Second Address | Warwick, NY 10990-1025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P470502 | OXFORD (01) | NY |
T52252 | (02) | NY |