Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 006763 | GA |
NPI | 1235254970 |
---|---|
Provider Name | Dr. James Todd Seidler |
First Address | Kennesaw, GA 30152-3452 |
Second Address | Snellville, GA 30678-6191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |