Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR002164 | GA |
NPI | 1013015015 |
---|---|
Provider Name | Dr. David Dow Black III |
First Address | Cornelia, GA 30531-2353 |
Second Address | Cornelia, GA 30531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T97422 | (02) |