Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 1843 | ALABAMA | No |
| 2 | 111N00000X | Chiropractor | | X008328 | NEW YORK | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 99871 | OTHER | NEW YORK | HEALTH PARTNERS |
| 2 | 0579923001 | OTHER | NEW YORK | CIGNA |
| 3 | 0579923001 | OTHER | NEW YORK | CIGNA PPO |
| 4 | 08238 | OTHER | NEW YORK | LANDMARK |
| 5 | 83289 | OTHER | NEW YORK | SPECIAL FUNDS |
| 6 | CO8328-9B | OTHER | NEW YORK | WORKERS COMP BOARD SO. |
| 7 | 50130 | OTHER | NEW YORK | PRISM |
| 8 | 926881 | OTHER | NEW YORK | MANAGED PHYSICAL NETWORK |
| 9 | 0579923003 | OTHER | NEW YORK | CIGNA HEALTHCARE |
| 10 | 1C8150 | OTHER | NEW YORK | HEALTH NET PPO |
| 11 | 4366499 | OTHER | NEW YORK | AETNA US HEALTHCARE |
| 12 | 5342643 | OTHER | NEW YORK | AETNA US HEALTHCARE |
| 13 | CO8328-9B | OTHER | NEW YORK | WORKERS COMP BOARD NO. |
| 14 | 83289 | OTHER | NEW YORK | THE PMA GROUP |
| 15 | P515078 | OTHER | NEW YORK | OXFORD |
| 16 | X92621 | MEDICARE PIN | NEW YORK | |
