Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | B01047 | NV |
Y | 111NN1001X | Nutrition | B01047 | NV |
NPI | 1568603447 |
---|---|
Provider Name | Dr. John Fitzgerald |
First Address | Las Vegas, NV 89123-1172 |
Second Address | Las Vegas, NV 89123-1172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 23/03/2009 |