Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 007060-L | PA |
NPI | 1790825784 |
---|---|
Provider Name | Dr. Tricia Michael Eyerly |
First Address | Conyngham, PA 18219-0492 |
Second Address | Conyngham, PA 18219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U67178 | (02) | PA |