Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X008229-1 | NY |
NPI | 1326093857 |
---|---|
Provider Name | Dr. Marc S. Taczanowski |
First Address | Saint James, NY 11780 |
Second Address | Saint James, NY 11780-1961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |