Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1745 | TN |
NPI | 1013036458 |
---|---|
Provider Name | Mr. Cory Robert Shapiro |
First Address | Hendersonville, TN 37075 |
Second Address | Hendersonville, TN 37075-3888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 23/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3145758C | BCBS (01) | |
661223 | ACN (01) | |
U79687 | (02) |