Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC24721 | CA |
N | 111NX0100X | Occupational Health | DC24721 | CA |
NPI | 1932143674 |
---|---|
Provider Name | Dr. Jeffrey Dean Hiner |
First Address | San Luis Obispo, CA 93401-7339 |
Second Address | San Luis Obispo, CA 93401-7339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC24721 | STATE LICENSE (01) | CA |
U73726 | (02) | CA |