Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 16052575 | PA |
NPI | 1568452019 |
---|---|
Provider Name | James R Heller |
First Address | Springfield, PA 19064-3071 |
Second Address | Springfield, PA 19064-3071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
417150 | (02) | PA |