Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC007919L | PA |
NPI | 1023102233 |
---|---|
Provider Name | Dr. William Harry Wertman JR. |
First Address | Kingston, PA 18704 |
Second Address | Kingston, PA 18704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U82872 | (02) | PA |