Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00370700 | NJ |
NPI | 1306978564 |
---|---|
Provider Name | Kenneth M Ermann |
First Address | Teaneck, NJ 07666-1703 |
Second Address | Teaneck, NJ 07666-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |