Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2652 | TN |
N | 111N00000X | Chiropractor | DC32149 | CA |
NPI | 1003185810 |
---|---|
Provider Name | Mr. Miro Bandalo |
First Address | Nolensville, TN 37135 |
Second Address | Nolensville, TN 37135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 14/08/2013 |