Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08002244A | IN |
N | 111NS0005X | Chiropractic Sports Physician | 08002244A | IN |
NPI | 1255382420 |
---|---|
Provider Name | Dr. Marcus Ansel Mccray |
First Address | Indianapolis, IN 46268 |
Second Address | Indianapolis, IN 46268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 30/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V10153 | (02) | IN |