Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2717 | TX |
NPI | 1629414545 |
---|---|
Provider Name | Dr. Joel F Bacon |
First Address | Del Rio, TX 78840-3577 |
Second Address | Del Rio, TX 78840-3577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2013 |
Last Update Date | 19/05/2013 |