Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7964 | TX |
N | 111NN1001X | Nutrition | 7964 | TX |
NPI | 1447259312 |
---|---|
Provider Name | Dr. David W Adams |
First Address | Longview, TX 75601-2912 |
Second Address | Longview, TX 75601-2912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72472 | (02) | TX |