Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301010079 | MI |
NPI | 1003215369 |
---|---|
Provider Name | Dr. Kody Semrow |
First Address | Holland, MI 49423-9257 |
Second Address | Holland, MI 49423-9257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2014 |
Last Update Date | 22/08/2014 |