Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 08003235A | IN |
NPI | 1346814746 |
---|---|
Provider Name | Parker Grundman |
First Address | Indianapolis, IN 46202-3377 |
Second Address | Indianapolis, IN 46202-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2021 |
Last Update Date | 19/05/2021 |