Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4855-12 | WI |
NPI | 1003188509 |
---|---|
Provider Name | Dr. Samuel Robert Klinner |
First Address | Medford, WI 54451-1852 |
Second Address | Medford, WI 54451-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2012 |
Last Update Date | 31/01/2012 |