Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4627 | KS |
NPI | 1225133028 |
---|---|
Provider Name | Sidney Allen Unruh |
First Address | Goodland, KS 67735-2942 |
Second Address | Goodland, KS 67735-2942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75632 | (02) | KS |