Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC002054L | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC002054L | PA |
NPI | 1114115441 |
---|---|
Provider Name | Dr. Joseph Steven Ulichny |
First Address | Hazleton, PA 18201-5879 |
Second Address | Hazleton, PA 18201-5879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 11/10/2007 |