Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH0001769 | FL |
N | 111NN0400X | Neurology | CH0001769 | FL |
NPI | 1831292150 |
---|---|
Provider Name | Dr. Donald J Krippendorf |
First Address | St. Petersburg, FL 33709 |
Second Address | St Petersburg, FL 33709-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050460200 | (05) | FL |
2214123 | AETNA HMO (01) | FL |
89606 | BLUE CROSS/BLUE SHIELD (01) | FL |
T56274 | (02) | FL |