Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 073490 | IA |
NPI | 1003249608 |
---|---|
Provider Name | Emily R Wentworth |
First Address | Mt Pleasant, IA 52641-1843 |
Second Address | Mt Pleasant, IA 52641-1843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 16/07/2014 |