Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 012849 | NY |
N | 111NI0013X | Independent Medical Examiner | 012849 | NY |
N | 111NR0400X | Rehabilitation Chiropractor | 012849 | NY |
NPI | 1194175331 |
---|---|
Provider Name | Victor Casanova |
First Address | New York, NY 10001-5657 |
Second Address | New York, NY 10001-5657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2016 |
Last Update Date | 04/10/2016 |