Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC002717L | PA |
NPI | 1003891078 |
---|---|
Provider Name | Dr. Nicholas Spano |
First Address | Canton, PA 17724-1211 |
Second Address | Canton, PA 17724-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001475170003 | (05) | PA |
120976 | BLUE SHIELD (01) | |
T72549 | (02) |