Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X1700 | NY |
NPI | 1003985086 |
---|---|
Provider Name | Dr. Daniel Edgar Burgdorf |
First Address | Rome, NY 13440-2136 |
Second Address | Rome, NY 13440-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C01700-6 | WCB AUTHORIZATION NUMBER (01) | NY |