Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5493 | CO |
NPI | 1245255017 |
---|---|
Provider Name | Dr. Mark A Addante |
First Address | Salida, CO 81201-3252 |
Second Address | Salida, CO 81201-3252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 02/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88172 | (02) | CO |