Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-003473 | IL |
NPI | 1003276536 |
---|---|
Provider Name | Robert Kieffer |
First Address | Waukegan, IL 60079-8288 |
Second Address | Waukegan, IL 60087-2928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 25/02/2016 |