Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4917 | KY |
N | 111NP0017X | Pediatric Chiropractor | 4917 | KY |
NPI | 1184637878 |
---|---|
Provider Name | Matthew Michael True |
First Address | Russell Springs, KY 42642 |
Second Address | Russell Springs, KY 42642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85003648 | (05) | KY |