Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC006575-L | PA |
NPI | 1114923091 |
---|---|
Provider Name | Dr. Jane L. Mcbride |
First Address | Havertown, PA 19083-5320 |
Second Address | Havertown, PA 19083-5320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0159641503 | (05) | PA |
U62228 | (02) | PA |