Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC12484 | CA |
NPI | 1023002581 |
---|---|
Provider Name | Dr. David H. Mortensen |
First Address | La Crescenta, CA 91214-2715 |
Second Address | La Crescenta, CA 91214-2715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 12/06/2008 |