Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11777 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 5200 | TX |
NPI | 1366670853 |
---|---|
Provider Name | Dr. Dorea Wilder Neigert |
First Address | Austin, TX 78704-4081 |
Second Address | Austin, TX 78745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 03/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11777 | TEXAS LICENSE (01) | TX |