Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0103779 | KS |
NPI | 1003870684 |
---|---|
Provider Name | Randall D Jasperson |
First Address | Salina, KS 67401-5204 |
Second Address | Salina, KS 67401-5204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44103 | (02) | KS |