Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 34890 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 34890 | CA |
NPI | 1023628229 |
---|---|
Provider Name | Dr. Jamor Townsend |
First Address | Beverly Hills, CA 90212-3467 |
Second Address | Beverly Hills, CA 90212-3467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |