Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 08000425A | IN |
Y | 111NR0400X | Rehabilitation Chiropractor | 08000425A | IN |
NPI | 1376720656 |
---|---|
Provider Name | Dr. Peter G Furno |
First Address | Indianapolis, IN 46260-2074 |
Second Address | Indianapolis, IN 46260-2074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
090992 | BLUE CROSS BLUE SHIELD (01) | IN |