Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | 4788 | NC |
NPI | 1134684467 |
---|---|
Provider Name | Vivian Barbour Federowicz |
First Address | Raleigh, NC 27615-4099 |
Second Address | Raleigh, NC 27616-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |