Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 60610321 | WA |
NPI | 1265888291 |
---|---|
Provider Name | Miguel Guajardo |
First Address | Kennewick, WA 99336-7801 |
Second Address | Kennewick, WA 99336-7801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 09/05/2016 |