Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 11599 | TX |
N | 111NN1001X | Nutrition | 11599 | TX |
Y | 111NS0005X | Chiropractic Sports Physician | 11599 | TX |
NPI | 1851693873 |
---|---|
Provider Name | Michael Dewayne Vennell |
First Address | Amarillo, TX 79119-6405 |
Second Address | Amarillo, TX 79119-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2010 |
Last Update Date | 07/11/2018 |