Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1060LA | LA |
NPI | 1154467942 |
---|---|
Provider Name | Dr. Kerry Dee Tarvin |
First Address | Shreveport, LA 71107-3812 |
Second Address | Shreveport, LA 71107-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |