Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 161 | WY |
NPI | 1043751852 |
---|---|
Provider Name | Mary L Smith |
First Address | Cheyenne, WY 82001-1377 |
Second Address | Cheyenne, WY 82001-1377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |