Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00639900 | NJ |
NPI | 1003914623 |
---|---|
Provider Name | Dr. Michael Simon Hendley |
First Address | Atlantic City, NJ 08401-3302 |
Second Address | Somers Point, NJ 08244-2380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102296 | (05) | NJ |
010853392 | BLUE CROSS/BLUE SHIELD (01) | NJ |
2724753000 | AMERIHEALTH (01) | NJ |