Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH5961 | FL |
N | 111NI0013X | Independent Medical Examiner | CH 5961 | FL |
N | 111NN1001X | Nutrition | CH 5961 | FL |
N | 111NS0005X | Chiropractic Sports Physician | CH 5961 | FL |
NPI | 1154515757 |
---|---|
Provider Name | Robert W. Schramm |
First Address | West Palm Beach, FL 33410-6307 |
Second Address | West Palm Beach, FL 33410-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K1053 | MEDICARE SENDER # (01) | FL |
U12708 | (02) | FL |