Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5820 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 3441 | AZ |
NPI | 1184762593 |
---|---|
Provider Name | Dr. Edward A Traum |
First Address | Tempe, AZ 85282-7503 |
Second Address | Tempe, AZ 85282-7503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 09/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U80777 | (02) | AZ |