Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 006093 | NY |
NPI | 1245307685 |
---|---|
Provider Name | Dr. Robert Thomas Owens |
First Address | Eden, NY 14057 |
Second Address | Eden, NY 14057-1230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |