Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 333 | CT |
NPI | 1265442834 |
---|---|
Provider Name | Dr. Keith Scott Overland |
First Address | Norwalk, CT 06851-4902 |
Second Address | Norwalk, CT 06851-4902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T22187 | (02) | CT |