Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | T16186 | AR |
NPI | 1043716459 |
---|---|
Provider Name | Jacob Goldberg |
First Address | Batesville, AR 72503-2731 |
Second Address | Batesville, AR 72501-6949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |