Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1438 | NC |
NPI | 1003881087 |
---|---|
Provider Name | Dr. Jill Brown Trull |
First Address | Kannapolis, NC 28083 |
Second Address | Kannapolis, NC 28083-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 30/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08849 | BCBSNC (01) | NC |
8908849 | (05) | NC |
T64447 | (02) |