Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1353 | CO |
NPI | 1275630535 |
---|---|
Provider Name | Robert M Masteller |
First Address | Longmont, CO 80501-1469 |
Second Address | Longmont, CO 80501-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |