Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08001678A | IN |
NPI | 1003854290 |
---|---|
Provider Name | Dr. George Charles Joachim |
First Address | Fort Wayne, IN 46815 |
Second Address | Fort Wayne, IN 46815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000092692 | BC BS ID # (01) | IN |
200092760A | (05) | IN |
35-2036658 | GROUP # (TAX ID) (01) | IN |
U61055 | (02) | IN |