Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104001138 | VA |
NPI | 1366540676 |
---|---|
Provider Name | Dr. Howard Richard Van Nostrand |
First Address | Bristow, VA 20136-2202 |
Second Address | Bristow, VA 20136-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000300748 | (05) | VA |
VAA101712 | (02) | VA |