Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 17303 | CA |
NPI | 1366650731 |
---|---|
Provider Name | Dr. Craig Carey Keoshian |
First Address | Valencia, CA 91355-1337 |
Second Address | Valencia, CA 91355-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |