Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC22364 | CA |
NPI | 1073501342 |
---|---|
Provider Name | Dr. James Edgar Hazard JR. |
First Address | Santa Ynez, CA 93460-0142 |
Second Address | Santa Ynez, CA 93460-9151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/07/2007 |