Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4384 | NC |
N | 111NN0400X | Neurology | 4384 | NC |
NPI | 1023309077 |
---|---|
Provider Name | Dr. Mark Francis Luongo |
First Address | Durham, NC 27707-5734 |
Second Address | Durham, NC 27707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 27/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023309077 | CHIROPRACTIC (01) | NC |