Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC14004 | CA |
NPI | 1104845122 |
---|---|
Provider Name | Dr. Craig L. Dillman |
First Address | San Diego, CA 92117-3661 |
Second Address | San Diego, CA 92117-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T17669 | (02) | CA |