Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 18358 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC18358 | CA |
NPI | 1164453460 |
---|---|
Provider Name | Diane Christopherson |
First Address | Laguna Beach, CA 92651-3103 |
Second Address | Laguna Beach, CA 92651-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 09/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10505 | (02) | CA |
DC0183580 | BLUE SHIELD (01) | CA |