Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1421 | OR |
NPI | 1790747939 |
---|---|
Provider Name | Dr. Charles A Simpson |
First Address | Cornelius, OR 97113-6037 |
Second Address | Cornelius, OR 97113-6037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 08/07/2007 |