Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104556696 | VA |
N | 111NN0400X | Neurology | 0104556696 | VA |
NPI | 1962640573 |
---|---|
Provider Name | Michael Amare |
First Address | Virginia Beach, VA 23452-1188 |
Second Address | Virginia Beach, VA 23452-1188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 12/11/2010 |