Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 004774-1 | NY |
NPI | 1093891962 |
---|---|
Provider Name | Dr. Douglas J. Vanvorst |
First Address | Schenectady, NY 12305-1119 |
Second Address | Amsterdam, NY 12010-7532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26736 | (02) | NY |