Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC007565L | PA |
NPI | 1245449420 |
---|---|
Provider Name | Dr. Paul Andrew Boris |
First Address | Smithton, PA 15479-0443 |
Second Address | Smithton, PA 15479-0443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |