Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2783 | OH |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2783 | OH |
NPI | 1801975875 |
---|---|
Provider Name | Dr. Paul David Agee |
First Address | Ashland, OH 44805-2832 |
Second Address | Ashland, OH 44805-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000122773 | ANTHEM BC/BS (01) | OH |
2113662 | (05) | OH |
U75321 | (02) | OH |