Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1673 | WI |
NPI | 1205927951 |
---|---|
Provider Name | Dr. Jay J Meverden |
First Address | Wausau, WI 54403-8634 |
Second Address | Wausau, WI 54401-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38770900 | (05) | WI |
T62755 | (02) | WI |