Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 157 | AK |
N | 111NR0400X | Rehabilitation Chiropractor | 737 | AK |
NPI | 1073658837 |
---|---|
Provider Name | Dr. Mary Lorene Pfeifer |
First Address | Ketchikan, AK 99901-5765 |
Second Address | Ketchikan, AK 99901-5765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH0157 | (05) | AK |