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 | | 001119L | PENNSYLVANIA | 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 | BSPBU5R84005 | OTHER | | ELECTRONIC BILLING |
| 2 | 121006KPK | MEDICARE ID-TYPE UNSPECIFIED | | & BLUE SHIELD DINCHER |
| 3 | 010101 | MEDICARE ID-TYPE UNSPECIFIED | | CHRONIC |
| 4 | 2512627 | OTHER | | AETNA PROV #S CLINIC |
| 5 | MEDICAREPRJ15T8001 | OTHER | | ELECTRONIC BILLING |
| 6 | 1704734001 | OTHER | | CIGNA PROV #S CARVER |
| 7 | 1438356001 | OTHER | | CIGNA PROV #S HERD |
| 8 | T29080 | MEDICARE UPIN | | |
| 9 | CALORAD | OTHER | | ASHLINK |
| 10 | JH018019 | OTHER | | ASHLINK |
| 11 | 5751845001 | OTHER | | CIGNA PROV #S DINCHER |
| 12 | 001119L | OTHER | | LICENSE NUMBERS HERD |
| 13 | 658218KPK | MEDICARE ID-TYPE UNSPECIFIED | | & BLUE SHIELD CARVER |
| 14 | 115888KPK | MEDICARE ID-TYPE UNSPECIFIED | | & BLUE SHIELD HERD |
| 15 | 010100 | MEDICARE OSCAR/CERTIFICATION | | |
