Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6092 | TX |
Y | 111NS0005X | Chiropractic Sports Physician | 6092 | TX |
NPI | 1104833714 |
---|---|
Provider Name | Mark Victor Mohnac |
First Address | Irving, TX 75062 |
Second Address | Irving, TX 75062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 09/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U47633 | (02) | TX |