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 | | 236-0686C | NEW HAMPSHIRE | 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 | 5411 | OTHER | NEW HAMPSHIRE | CIGNA |
| 2 | 761532 | OTHER | NEW HAMPSHIRE | TUFTS HEALTH PLAN |
| 3 | Y39724 | OTHER | NEW HAMPSHIRE | BCBS MA |
| 4 | 04-65350 | OTHER | NEW HAMPSHIRE | UNITED HEALTHCARE |
| 5 | 020417401 | OTHER | NEW HAMPSHIRE | GREAT WEST |
| 6 | RE2188 | MEDICARE ID-TYPE UNSPECIFIED | NEW HAMPSHIRE | MEDICARE |
| 7 | 020417401 | OTHER | NEW HAMPSHIRE | MAIL HANDLERS |
| 8 | NA1572 | OTHER | NEW HAMPSHIRE | HARVARD PILGRIM |
| 9 | 020417401 | OTHER | NEW HAMPSHIRE | NGS AMERICAN |
| 10 | 1163089 | OTHER | NEW HAMPSHIRE | FIRST HEALTH |
| 11 | 544350 | OTHER | NEW HAMPSHIRE | AETNA |
| 12 | RE2188 | OTHER | NEW HAMPSHIRE | BCBS MA |
| 13 | 020417401 | OTHER | NEW HAMPSHIRE | HEALTHCARE MANAGEMENT |
| 14 | 0504627Y0NH01 | OTHER | NEW HAMPSHIRE | ANTHEM |
| 15 | GA44-04092 | OTHER | NEW HAMPSHIRE | UNITED HEALTHCARE- GA |
| 16 | 020417401 | OTHER | NEW HAMPSHIRE | BENEFIT ADMINISTRATORS |
| 17 | 020417401 | OTHER | NEW HAMPSHIRE | UNICARE |
