Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 022 A05916 | IA |
NPI | 1235239104 |
---|---|
Provider Name | Dr. David Leonard Pratt |
First Address | Oelwein, IA 50662-1938 |
Second Address | Oelwein, IA 50662-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UO 58313 | (02) | IA |