Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 652 | WY |
NPI | 1003988213 |
---|---|
Provider Name | Dr. Patrick J Kirsch |
First Address | Sheridan, WY 82801-3911 |
Second Address | Sheridan, WY 82801-3911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08092 | (02) | WY |