Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC #304 | HI |
NPI | 1265586747 |
---|---|
Provider Name | Dr. Christopher Mitchell Nowicki |
First Address | Pearl City, HI 96782-2638 |
Second Address | Pearl City, HI 96782-2638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T83235 | (02) | HI |