Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC18169 | CA |
NPI | 1487685574 |
---|---|
Provider Name | Dr. Gary T. Weckbacher |
First Address | Montrose, CA 91020-1605 |
Second Address | Montrose, CA 91020-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T06635 | (02) | CA |