Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 0104556504 | VA |
N | 111NP0017X | Pediatric Chiropractor | S03521 | MD |
NPI | 1851539118 |
---|---|
Provider Name | Dr. Carmel Dekel Wiseman |
First Address | Centreville, VA 20121-3502 |
Second Address | Fairfax, VA 22030-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2009 |
Last Update Date | 29/03/2012 |