Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2366 | TX |
NPI | 1538230974 |
---|---|
Provider Name | Mr. Edward Walter Rongers |
First Address | Fruitvale, TX 75127 |
Second Address | Wills Point, TX 75169-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T15624 | (02) | TX |