Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 554 | WV |
N | 213ER0200X | Radiology | 554 | WV |
Y | 111NR0400X | Rehabilitation Chiropractor | 554 | WV |
N | 111NS0005X | Chiropractic Sports Physician | 554 | WV |
NPI | 1043429178 |
---|---|
Provider Name | Stephen R Thaxton |
First Address | Sissonville, WV 25320-9522 |
Second Address | Sissonville, WV 25320-9522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010707548 | MOUNTAIN STATE (01) | WV |
013224900 | (05) | WV |
U84657 | (02) | WV |