Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC20135 | CA |
N | 111NS0005X | Chiropractic Sports Physician | X006954 | NY |
NPI | 1124436258 |
---|---|
Provider Name | Dr. Donald Brosseau JR. |
First Address | Pacoima, CA 91331-2094 |
Second Address | Pacoima, CA 91331-2094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2014 |
Last Update Date | 01/08/2014 |