Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC13684 | CA |
NPI | 1003871153 |
---|---|
Provider Name | Dr. Antonio Soto JR. |
First Address | Stockton, CA 95207 |
Second Address | Stockton, CA 95207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5749 | UPIN (01) | WA |
T05101 | (02) |