Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2331-012 | WI |
NPI | 1356437958 |
---|---|
Provider Name | Dr. Mark A Dull |
First Address | Twin Lakes, WI 53181 |
Second Address | Twin Lakes, WI 53181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38931200 | (05) | WI |