Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 11882 | CA |
NPI | 1366441974 |
---|---|
Provider Name | Dr. Jan Murray Corwin |
First Address | Oakland, CA 94609-3037 |
Second Address | Oakland, CA 94609-3037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T04536 | (02) | CA |