Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR007426 | GA |
NPI | 1093877268 |
---|---|
Provider Name | Sean James Lotterer |
First Address | Cartersville, GA 30120-3330 |
Second Address | Cartersville, GA 30120-3330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |