Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5580 | OR |
N | 111NP0017X | Pediatric Chiropractor | 5580 | OR |
NPI | 1992947980 |
---|---|
Provider Name | Dr. Kacie Flegal |
First Address | Ashland, OR 97520-1877 |
Second Address | Mill Valley, CA 94941-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 18/11/2016 |