Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 713 | WV |
N | 111NN1001X | Nutrition | 713 | WV |
NPI | 1083705958 |
---|---|
Provider Name | James G Bombino |
First Address | Martinsburg, WV 25401-2835 |
Second Address | Martinsburg, WV 25401-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2202057000 | (05) | WV |