Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | A05303 | IA |
NPI | 1003915489 |
---|---|
Provider Name | Dr. Kevin William Paustian |
First Address | Durant, IA 52747-0715 |
Second Address | Durant, IA 52747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
231384 | MIDLANDS CHOICE (01) | |
25943 | BLUE CROSS/BLUE SHIELD (01) | |
T01470 | (02) |