Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2524 | MA |
NPI | 1003091448 |
---|---|
Provider Name | Eino William Ketola |
First Address | Stow, MA 01775-1561 |
Second Address | Southbridge, MA 01550-2561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 03/01/2008 |