Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301009467 | MI |
NPI | 1003079716 |
---|---|
Provider Name | Dr. Jason Dennis Tagai |
First Address | Chesterfield, MI 48051-2101 |
Second Address | Chesterfield, MI 48051-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 03/07/2008 |