Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | CHIR007941 | GA |
N | 111NX0100X | Occupational Health | 3776 | SC |
Y | 111NX0100X | Occupational Health | 4976 | NC |
NPI | 1124231600 |
---|---|
Provider Name | Dr. Richard Andrew Nagle III |
First Address | Matthews, NC 28104-6229 |
Second Address | Waxhaw, NC 28173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 11/05/2021 |