Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | S02007 | MD |
NPI | 1063541464 |
---|---|
Provider Name | Dr. Michael S Decriscio |
First Address | Hagerstown, MD 21740-6138 |
Second Address | Hagerstown, MD 21740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2007 |
Last Update Date | 20/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91830 | (02) | MD |
UNKNOWN | (02) | MD |