Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH7994 | FL |
NPI | 1003972662 |
---|---|
Provider Name | Dr. David Aaron Fontz |
First Address | Pensacola, FL 32526-1620 |
Second Address | Pensacola, FL 32526-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22348 | BLUE CROSS BLUE SHIELD (01) | FL |