Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1696 | OH |
NPI | 1346370384 |
---|---|
Provider Name | Dr. Peter J Fagerland |
First Address | Cincinnati, OH 45240-3221 |
Second Address | Cincinnati, OH 45240-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49788 | (02) | OH |