Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11335 | TX |
N | 111N00000X | Chiropractor | 2301004801 | MI |
NPI | 1003926866 |
---|---|
Provider Name | Ronald J Stark |
First Address | San Antonio, TX 78261 |
Second Address | San Antonio, TX 78261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 12/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950255003 | (02) |