Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 007141 | IA |
NPI | 1063667855 |
---|---|
Provider Name | Dr. Tim Daniel Gearhart |
First Address | Oelwein, IA 50662-1938 |
Second Address | Oelwein, IA 50662-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2008 |
Last Update Date | 21/11/2008 |