Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10825 | TX |
NPI | 1003084633 |
---|---|
Provider Name | Samantha Ashley Ford |
First Address | Pampa, TX 79065-4018 |
Second Address | Pampa, TX 79065-5126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2008 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TXB161472 | (02) | TX |