Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH3794 | FL |
NPI | 1497883227 |
---|---|
Provider Name | Dr. Michael David Ville |
First Address | Satellite Beach, FL 32937-2993 |
Second Address | Satellite Beach, FL 32937-2993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |