Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 08001363 | IN |
NPI | 1083765259 |
---|---|
Provider Name | Dr. Mark John Dobson |
First Address | Demotte, IN 46310-8799 |
Second Address | Demotte, IN 46310-8799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45378 | (02) | IN |