Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CA 15843 | CA |
NPI | 1356642425 |
---|---|
Provider Name | Dr. Bryant Owens JR. |
First Address | Merced, CA 95340-3970 |
Second Address | Merced, CA 95340-3970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 15/01/2015 |