Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | A05317 | IA |
NPI | 1215923602 |
---|---|
Provider Name | Dr. Reggie Lauer Clifton |
First Address | Indianola, IA 50125-1635 |
Second Address | Offutt A F B, NE 68113-1043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/07/2007 |