Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC26412 | CA |
NPI | 1144304981 |
---|---|
Provider Name | Dr. David Lee Jackel |
First Address | El Cajon, CA 92019-4493 |
Second Address | El Cajon, CA 92019-4493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
677108 | (02) | CA |