Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 004770 | MI |
NPI | 1336267046 |
---|---|
Provider Name | Dr. Keith I Delap |
First Address | Waterford, MI 48328-1605 |
Second Address | Waterford, MI 48328-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950F35216 | (02) | MI |