Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | DC16812 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC16812 | CA |
N | 2251E1200X | Ergonomics | PT7100 | CA |
N | 225XE1200X | Ergonomics | PT7100 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT7100 | CA |
NPI | 1154409688 |
---|---|
Provider Name | Dr. Joan Terry Plevin |
First Address | Lake Forest, CA 92630-4308 |
Second Address | Lake Forest, CA 92630-4308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 19/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PT71000 | BLUE SHIELD (01) | CA |