Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 08001109A | IN |
N | 111NS0005X | Chiropractic Sports Physician | 08001109A | IN |
N | 111NX0100X | Occupational Health | 08001109A | IN |
NPI | 1972525210 |
---|---|
Provider Name | Dr. William J Misenheimer |
First Address | Monticello, IN 47960-2001 |
Second Address | Monticello, IN 47960-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100262770A | (05) | IN |
U29799 | (02) | IN |