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 | | 002730L | 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 | 2512627 | OTHER | | AETNA CLINIC |
| 2 | 004479L | OTHER | | LICENSE CARVER |
| 3 | 01591101 | OTHER | | BLUE CROSS PROV DINCHER |
| 4 | 2512613 | OTHER | | AETNA CARVER |
| 5 | 01580501 | OTHER | | BLUE CROSS PROV HERD |
| 6 | 02012401 | OTHER | | BLUE CROSS PROV CARVER |
| 7 | U12484 | MEDICARE UPIN | | |
| 8 | 001119L | OTHER | | LICENSE HERD |
| 9 | 2512654 | OTHER | | AETNA DINCHER |
| 10 | 2512654 | OTHER | | AETNA HERD |
| 11 | T29254 | MEDICARE UPIN | | |
| 12 | BSPBU5R84005 | OTHER | | ELECTRONIC BILLING |
| 13 | PRJ15T8001 | MEDICARE ID-TYPE UNSPECIFIED | | ELECTRONIC BILLING |
| 14 | 002730L | OTHER | | LICENSE DINCHER |
| 15 | T29080 | MEDICARE UPIN | | |
| 16 | 010101 | MEDICARE ID-TYPE UNSPECIFIED | | CHRONIC |
| 17 | 706271 | OTHER | | BLUE SHIELD PROV # |
| 18 | 02561600 | OTHER | | BLUE CROSS PROV # |
| 19 | 010100 | MEDICARE OSCAR/CERTIFICATION | | |
