Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC25275 | CA |
NPI | 1114137742 |
---|---|
Provider Name | Dr. Bobby Lawrence Smith |
First Address | Fontana, CA 92335-8649 |
Second Address | Fontana, CA 92335-8649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |