Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301002789 | MI |
N | 111NN1001X | Nutrition | 2301002789 | MI |
NPI | 1427288182 |
---|---|
Provider Name | Larry M Robison |
First Address | Ypsilanti, MI 48198-1000 |
Second Address | Warren, MI 48088-1983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 09/08/2010 |