Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 25114 | CA |
NPI | 1003996810 |
---|---|
Provider Name | Dr. Colleen Candace Cork |
First Address | Duarte, CA 91010-2486 |
Second Address | Duarte, CA 91010-2486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |