Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4343 | AZ |
N | 111NN0400X | Neurology | 4343 | AZ |
NPI | 1306804984 |
---|---|
Provider Name | Dr. Nathan S Conlee |
First Address | Tucson, AZ 85716 |
Second Address | Tucson, AZ 85716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 24/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T76862 | (02) |