Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 32704 | CA |
NPI | 1174956718 |
---|---|
Provider Name | Dr. Christopher Warren Coulsby |
First Address | Coronado, CA 92118-4411 |
Second Address | Coronado, CA 92118-4411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 23/06/2020 |