Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH5986 | FL |
NPI | 1265509517 |
---|---|
Provider Name | Dr. Michael Keith Bagnell |
First Address | Palmetto Bay, FL 33157-1928 |
Second Address | Palmetto Bay, FL 33157-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 14/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22508 | (02) | FL |