Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4025 | OR |
N | 111N00000X | Chiropractor | AJ010061 | PA |
N | 111N00000X | Chiropractor | DC010260 | PA |
NPI | 1003137977 |
---|---|
Provider Name | Joanna Rae Sutton |
First Address | Hermiston, OR 97838-1536 |
Second Address | Hermiston, OR 97838-1536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 15/06/2010 |