Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC22260 | CA |
NPI | 1235123266 |
---|---|
Provider Name | Dr. Chris Wendell |
First Address | Tustin, CA 92780-3655 |
Second Address | Tustin, CA 92780-3655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 11/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44724 | (02) | CA |