Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 08003086A | IN |
NPI | 1497303994 |
---|---|
Provider Name | Emily Welch |
First Address | Portland, IN 47371-1344 |
Second Address | Portland, IN 47371-1344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |