Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | SD935 | SD |
NPI | 1194790568 |
---|---|
Provider Name | Dr. Wayne Robert Huber JR. |
First Address | Tea, SD 57064-2276 |
Second Address | Tea, SD 57064-2276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7604660 | (05) | SD |
80961 | (02) | SD |