Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1731 | OH |
N | 111NN0400X | Neurology | 1731 | OH |
N | 111NR0200X | Radiology | 1731 | OH |
N | 213ER0200X | Radiology | 1731 | OH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1731 | OH |
NPI | 1134119092 |
---|---|
Provider Name | Dr. Carl Richard Dollison |
First Address | Cambridge, OH 43725-2854 |
Second Address | Cambridge, OH 43725-2854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 31/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0975388 | (05) | OH |
311410997-00 | OHIO BWC (01) | OH |
U49945 | (02) | OH |