Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC006470L | PA |
NPI | 1184601395 |
---|---|
Provider Name | Dr. John Donald Rawa JR. |
First Address | Girard, PA 16417-1822 |
Second Address | Girard, PA 16417-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 21/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017811730001 | (05) | PA |
G1807058 | BLUE CROSS (01) | PA |
U64295 | (02) | PA |