Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 0104001257 | VA |
N | 111NR0400X | Rehabilitation Chiropractor | DC005534L | PA |
NPI | 1114065026 |
---|---|
Provider Name | Dr. John Patrick Mcnamara |
First Address | Salem, VA 24153-3836 |
Second Address | Salem, VA 24153-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240716 | ANTHEM BCBS (01) | VA |
T01619 | (02) | VA |