Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 441 | WV |
NPI | 1407961634 |
---|---|
Provider Name | Dr. Jeffrey Lee Summers |
First Address | Charleston, WV 25364-4003 |
Second Address | Charleston, WV 25304-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131439000 | (05) | WV |
T32412 | (02) | WV |