Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 32020 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 32020 | CA |
NPI | 1003113259 |
---|---|
Provider Name | Dr. Ian Philipe Ahearn |
First Address | San Diego, CA 92110-4854 |
Second Address | San Diego, CA 92110-4854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2011 |
Last Update Date | 19/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32020 | LICENSE (01) | CA |