Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 006654 | MO |
NPI | 1013016039 |
---|---|
Provider Name | Joanne Elisabeth Mariano |
First Address | Kansas City, MO 64114 |
Second Address | Kansas City, MO 64114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 15/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U77653 | (02) |