Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0959 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 1386 | AZ |
NPI | 1053378042 |
---|---|
Provider Name | Dr. Larry Allen Finch |
First Address | Kingman, AZ 86401 |
Second Address | Kingman, AZ 86401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0085720 | BLUE CROSS ID # (01) | AZ |