Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 01-03532 | KS |
NPI | 1245425099 |
---|---|
Provider Name | Rodney Paul Poe |
First Address | Andover, KS 67002-0593 |
Second Address | Andover, KS 67002-9616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 05/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
062437 | BC/BS (01) | KS |
3013 | PHS (01) | KS |