Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.013145 | IL |
N | 111NP0017X | Pediatric Chiropractor | 1878 | NE |
NPI | 1619337813 |
---|---|
Provider Name | Justina Adair |
First Address | Oblong, IL 62449-1465 |
Second Address | Oblong, IL 62449-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2016 |
Last Update Date | 19/05/2021 |