Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3301861202 | UT |
NPI | 1104018696 |
---|---|
Provider Name | Dr. Leon Andre Erasmus |
First Address | Murray, UT 84107-7257 |
Second Address | Murray, UT 84107-7257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 17/08/2007 |