Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1483 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 1483 | WI |
NPI | 1346336096 |
---|---|
Provider Name | Kenneth A. Urban |
First Address | Green Bay, WI 54302-2739 |
Second Address | Green Bay, WI 54302-2739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 28/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38757000 | (05) | WI |