Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 306 | WY |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 306 | WY |
NPI | 1649275066 |
---|---|
Provider Name | Dr. Daniel Robert Staight |
First Address | Casper, WY 82601-3030 |
Second Address | Casper, WY 82601-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118403200 | (05) | WY |
T44183 | (02) | WY |