Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4111 | OH |
N | 111NN1001X | Nutrition | 4111 | OH |
NPI | 1346512977 |
---|---|
Provider Name | Dr. Matthew Kola |
First Address | Delaware, OH 43015-7970 |
Second Address | Delaware, OH 43015-7970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2012 |
Last Update Date | 27/01/2012 |