Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC007358L | PA |
NPI | 1003019100 |
---|---|
Provider Name | Patricia Coughlin |
First Address | Wayne, PA 19087-4748 |
Second Address | Wayne, PA 19087-4748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |