Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0005372 | FL |
NPI | 1417149170 |
---|---|
Provider Name | Lana Perkins |
First Address | Fort Myers, FL 33907-2323 |
Second Address | Fort Myers, FL 33907-2323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 11/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70839 | BCBS (01) | FL |
T94459 | (02) | FL |