Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC12713 | CA |
N | 111NR0200X | Radiology | DC12713 | CA |
N | 213ER0200X | Radiology | DC12713 | CA |
NPI | 1093837684 |
---|---|
Provider Name | Dr. Jack Isbell |
First Address | Stevenson Ranch, CA 91381-1143 |
Second Address | Mission Hills, CA 91345-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |