Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301010664 | MI |
NPI | 1003313842 |
---|---|
Provider Name | Mackenzie Kate Goss |
First Address | Sterling Heights, MI 48310-4107 |
Second Address | Sterling Heights, MI 48310-4107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 09/04/2018 |