Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 0362 | WV |
NPI | 1124153572 |
---|---|
Provider Name | Mr. Donald J D'lusky II |
First Address | Fairmont, WV 26554 |
Second Address | Fairmont, WV 26554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 03/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55-0668436 | (02) | WV |