Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2301009733 | MI |
NPI | 1235443763 |
---|---|
Provider Name | Dr. Ryan Deubel |
First Address | Holt, MI 48842-1147 |
Second Address | Holt, MI 48842-1147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 28/10/2010 |