Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | B 149 | NV |
NPI | 1760482756 |
---|---|
Provider Name | Dr. Richard Matthew Mcintyre |
First Address | Henderson, NV 89052-8514 |
Second Address | Las Vegas, NV 89123-8008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
668342 | ANTHEM BCBS HMO, PPO (01) | NV |
T37379 | (02) | NV |