Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4253 | TX |
NPI | 1003057977 |
---|---|
Provider Name | Dr. Ronald Edward Kohlstrand JR. |
First Address | Carrollton, TX 75006-4725 |
Second Address | Garland, TX 75042-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 23/03/2009 |