Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | B-262 | NV |
NPI | 1548386592 |
---|---|
Provider Name | Dr. Mark Joseph Mattoon SR. |
First Address | Carson City, NV 89703-2148 |
Second Address | Carson City, NV 89703-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |