Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0005440 | FL |
NPI | 1174534218 |
---|---|
Provider Name | Dr. Mitchell Anthony Womack |
First Address | Palm Bay, FL 32905-3829 |
Second Address | Palm Bay, FL 32905-3829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 29/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380015600 | (05) | FL |
U21704 | (02) |