Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301007040 | MI |
Y | 124Q00000X | Dental Hygienist | H01517 | AZ |
NPI | 1063470870 |
---|---|
Provider Name | Dr. Carol Marie Jaworski |
First Address | Kayenta, AZ 86033 |
Second Address | Kayenta, AZ 86033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
383518314 | TAX ID (01) | MI |
950C9502 | BCBS (01) | MI |
P93198 | BCN (01) | MI |
U63304 | (02) | MI |