Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1080 | LA |
NPI | 1003990367 |
---|---|
Provider Name | James Joseph Derbes |
First Address | Mandeville, LA 70448-3056 |
Second Address | Mandeville, LA 70448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 14/10/2008 |