Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | CA | |
Y | 111NS0005X | Chiropractic Sports Physician | DC11743 | CA |
NPI | 1346321569 |
---|---|
Provider Name | Anthony B Hawkins |
First Address | La Mesa, CA 91941-4950 |
Second Address | La Mesa, CA 91941-4950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC11743 | LICENSE (01) | CA |
T17176 | (02) | CA |