Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC011189 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ010948 | PA |
NPI | 1316493315 |
---|---|
Provider Name | Lara Garber |
First Address | Philadelphia, PA 19102-4017 |
Second Address | Philadelphia, PA 19102-4017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 30/08/2016 |