Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2080 | WA |
N | 111NS0005X | Chiropractic Sports Physician | 2080 | WA |
NPI | 1194811422 |
---|---|
Provider Name | Dr. Dennis Devlin |
First Address | Enumclaw, WA 98022-2549 |
Second Address | Enumclaw, WA 98022-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0095091 | DEPT OF LABOR & INDUSTRY (01) | WA |
2003226 | (05) | WA |