Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 18675 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 4102 | PA |
NPI | 1306904362 |
---|---|
Provider Name | Dr. Ronald Trkula |
First Address | Crescent, PA 15046-5312 |
Second Address | Crescent, PA 15046-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 10/02/2015 |