Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 27704 | CA |
NPI | 1013031236 |
---|---|
Provider Name | Dr. Brett W Stine |
First Address | Sonoma, CA 95476-6906 |
Second Address | Sonoma, CA 95476-6906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0277040 | PIN (01) | CA |