Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC023059 | CA |
NPI | 1073644811 |
---|---|
Provider Name | Dr. Gary Bradford Wright |
First Address | Anaheim, CA 92805-2960 |
Second Address | Anaheim, CA 92805-2960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC023059 | STATE LICENSE (01) | CA |
DC0230590 | (05) | CA |