Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH10173 | FL |
NPI | 1043395577 |
---|---|
Provider Name | Dr. David Miles Gladstone |
First Address | Miami Lakes, FL 33014-2473 |
Second Address | Miami Lakes, FL 33014-2473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 25/06/2011 |