Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33047 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33047 | CA |
NPI | 1063869345 |
---|---|
Provider Name | Dr. Jane Macris |
First Address | Costa Mesa, CA 92626-4858 |
Second Address | Costa Mesa, CA 92626-4858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2016 |
Last Update Date | 15/07/2019 |