Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 598 | WY |
NPI | 1013017243 |
---|---|
Provider Name | Dr. Scott Dean Popp |
First Address | Casper, WY 82609-4233 |
Second Address | Casper, WY 82609-4233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T31319 | (02) | WY |