A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Chiropractor | 111N00000X |
| Internist | 111NI0900X | |
| Pediatric Chiropractor | 111NP0017X | |
| Sports Physician | 111NS0005X |
* Indicates primary specialty
| NPI Number | 1720555790 |
| Credentials | D.C. (Doctor of Chiropractic) |
| Entity | Individual |
| Enumeration date | 10/29/2018 |
| Last updated | 07/16/2025 - About 11 months ago |
| Sole proprietor1 | Yes |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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