Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 04815 | NJ |
NPI | 1336249879 |
---|---|
Provider Name | Dr. Michael Stewart |
First Address | Glen Rock, NJ 07452-1745 |
Second Address | Glen Rock, NJ 07452-1745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 14/03/2008 |