Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC016011 | CA |
NPI | 1154352714 |
---|---|
Provider Name | Dr. Dave Randall Mull |
First Address | Long Beach, CA 90815-2364 |
Second Address | Long Beach, CA 90815-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |