Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 34691 | CA |
NPI | 1063088565 |
---|---|
Provider Name | Dr. Benjamin Frank Adams |
First Address | Winnetka, CA 91306-2677 |
Second Address | Winnetka, CA 91306-2677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34691 | CHIROPRACTIC LISENSE NUMBER (01) | CA |