Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | CHIR009161 | GA |
NPI | 1467859868 |
---|---|
Provider Name | Dr. Richard Cohen |
First Address | Marietta, GA 30067-4160 |
Second Address | Marietta, GA 30067-4160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 01/12/2014 |