Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00477400 | NJ |
NPI | 1023165552 |
---|---|
Provider Name | Jeffrey Scott Larkin |
First Address | Warren, NJ 07059-5154 |
Second Address | Warren, NJ 07059-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |