Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | B598 | NV |
NPI | 1306899489 |
---|---|
Provider Name | Roger M. Penna |
First Address | Las Vegas, NV 89128 |
Second Address | Las Vegas, NV 89128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 26/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U87578 | (02) | NV |