Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3458 | AZ |
NPI | 1215127360 |
---|---|
Provider Name | Dr. Keith Michael Stone |
First Address | Phoenix, AZ 85006-2524 |
Second Address | Phoenix, AZ 85006-2524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 25/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42191 | (02) | AZ |