Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1647 | WI |
NPI | 1801976279 |
---|---|
Provider Name | Dr. John Michael Haase |
First Address | Madison, WI 53705-2172 |
Second Address | Madison, WI 53705-2172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38767600 | (05) | WI |
T62086 | (02) | WI |