Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC2581L | PA |
NPI | 1134137961 |
---|---|
Provider Name | Mark T Stough |
First Address | Newtown, PA 18940 |
Second Address | Newtown, PA 18940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |