Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 786 | CT |
NPI | 1275681850 |
---|---|
Provider Name | Dr. David Glenn Axman |
First Address | Hamden, CT 06518-2391 |
Second Address | Hamden, CT 06518-2391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 07/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U02577 | (02) |