Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 16264 | AR |
NPI | 1003418443 |
---|---|
Provider Name | Dr. Cassidy Ransom |
First Address | North Little Rock, AR 72114-5526 |
Second Address | North Little Rock, AR 72114-5526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/11/2020 |