Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIA-678 | ID |
Y | 111NN1001X | Nutrition | CHIA-678 | ID |
NPI | 1497033666 |
---|---|
Provider Name | Dr. Stanley N Sears |
First Address | Caldwell, ID 83605-2256 |
Second Address | Caldwell, ID 83605-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 04/10/2012 |