Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 31479 | CA |
NPI | 1265762124 |
---|---|
Provider Name | Dr. Danny Basil Bachoua |
First Address | La Mesa, CA 91941-8301 |
Second Address | La Mesa, CA 91941-8301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2009 |
Last Update Date | 14/04/2010 |