Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 17438 | CA |
NPI | 1124084074 |
---|---|
Provider Name | Dr. Colin W Frogley |
First Address | Soquel, CA 95073-2457 |
Second Address | Soquel, CA 95073-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 11/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0174380 | (02) | CA |