Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 26680 | CA |
NPI | 1003898511 |
---|---|
Provider Name | Dr. Demeil Betoushana |
First Address | Turlock, CA 95380-2614 |
Second Address | Turlock, CA 95380-2614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 19/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U79664 | (02) | CA |