Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIA 654 | ID |
NPI | 1346357647 |
---|---|
Provider Name | James Edward Vancho |
First Address | Post Falls, ID 83854-9255 |
Second Address | Post Falls, ID 83854-9255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 14/07/2008 |