Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-005712 | IL |
NPI | 1013966050 |
---|---|
Provider Name | Dr. Kirk Alex Price |
First Address | Springfield, IL 62711-7053 |
Second Address | Springfield, IL 62704-4189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 24/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K24601 | (02) | IL |