Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 21259 | CA |
NPI | 1003967530 |
---|---|
Provider Name | Dr. Antonio Carbonell JR. |
First Address | Red Bluff, CA 96080-3337 |
Second Address | Red Bluff, CA 96080-3337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC 21259 | STATE LICENSE NO. (01) | CA |