Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 10296 | CA |
NPI | 1326021395 |
---|---|
Provider Name | C. Owen Bateson |
First Address | Susanville, CA 96130-4311 |
Second Address | Susanville, CA 96130-4311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T03885 | (02) | CA |