Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301004757 | MI |
Y | 111N00000X | Chiropractor | DC-04894 | OH |
N | 111NN1001X | Nutrition | 2301004757 | MI |
NPI | 1629029046 |
---|---|
Provider Name | Dr. Elia Acuna-Tindall |
First Address | Maumee, OH 43537-0628 |
Second Address | Maumee, OH 43537-0628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950E016250 | BLUE CROSS/BLUE SHIELD (01) | MI |