Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4634 | AZ |
NPI | 1619933959 |
---|---|
Provider Name | Dr. John Thomas Mccarthy |
First Address | Flagstaff, AZ 86004-4227 |
Second Address | Flagstaff, AZ 86004-4227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44497 | (02) | AZ |