Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH9098 | FL |
N | 111NN1001X | Nutrition | CH9098 | FL |
Y | 208D00000X | General Practice Physician | APRN11005504 | FL |
N | 208D00000X | General Practice Physician | CH9098 | FL |
NPI | 1487780433 |
---|---|
Provider Name | Dr. Craig Carl Jochum |
First Address | Stuart, FL 34994-4410 |
Second Address | Stuart, FL 34994-4410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APRN11005504 | NURSE PRACTITIONER (01) | FL |
CH9098 | CHIROPRACTOR (01) | FL |