Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10089 | TX |
NPI | 1003828492 |
---|---|
Provider Name | Mr. Wesley James Imel |
First Address | Dallas, TX 75254-6778 |
Second Address | Dallas, TX 75254-6778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08736 | (02) | TX |