Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC31100 | CA |
N | 111NP0017X | Pediatric Chiropractor | 136945 | CA |
NPI | 1720524069 |
---|---|
Provider Name | Anish Chandra |
First Address | Aliso Viejo, CA 92656-2698 |
Second Address | Aliso Viejo, CA 92656-2698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 10/01/2017 |