Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | S03476 | MD |
NPI | 1255584488 |
---|---|
Provider Name | Kissa Mcrae |
First Address | Silver Spring, MD 20901-1849 |
Second Address | Silver Spring, MD 20901-1849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2008 |
Last Update Date | 31/10/2008 |