Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00139600 | NJ |
NPI | 1871705285 |
---|---|
Provider Name | Dr. John Winn |
First Address | Saddle River, NJ 07458-3006 |
Second Address | Saddle River, NJ 07458-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102211000 | AMERIHEALTH ID NUMBER (01) | NJ |
35216389C | (05) | NJ |
BC00975 | BLUE CROSS BLUE SHIELD ID (01) | NJ |
T82425 | (02) | NJ |