Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 012709 | NY |
NPI | 1417305244 |
---|---|
Provider Name | Leah Humphries |
First Address | Owego, NY 13827-1420 |
Second Address | Owego, NY 13827-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 02/06/2016 |