Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC001555L | PA |
NPI | 1225018799 |
---|---|
Provider Name | Dr. William Tellin |
First Address | Pittsburgh, PA 15241-1208 |
Second Address | Pittsburgh, PA 15241-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00617323 | (05) | PA |
T29673 | (02) | PA |