Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC 23363 | CA |
NPI | 1295950053 |
---|---|
Provider Name | Dr. Heidi Rose Law |
First Address | San Rafael, CA 94901-3321 |
Second Address | San Rafael, CA 94901-3321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |