Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3291 | WA |
N | 111NS0005X | Chiropractic Sports Physician | 809 | MT |
N | 111NS0005X | Chiropractic Sports Physician | 843 | ID |
NPI | 1154404978 |
---|---|
Provider Name | Dr. Thomas Ovenell |
First Address | East Wenatchee, WA 98802-4481 |
Second Address | East Wenatchee, WA 98802-4481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2023711 | (05) | WA |
U62794 | (02) | WA |