Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 29774 | CA |
NPI | 1003991126 |
---|---|
Provider Name | Dr. Chaunce Phoenyx |
First Address | San Jose, CA 95112-2608 |
Second Address | San Jose, CA 95112-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 17/02/2021 |