Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC13478 | CA |
NPI | 1154433936 |
---|---|
Provider Name | Dr. David Michael Carletta |
First Address | Burbank, CA 91505-4534 |
Second Address | Burbank, CA 91505-4534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T17510 | (02) | CA |