Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00398100 | NJ |
NPI | 1003949256 |
---|---|
Provider Name | Dr. Michael John Latza |
First Address | Plainfield, NJ 07060-1206 |
Second Address | Plainfield, NJ 07060-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 19/03/2013 |