Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC16468 | CA |
NPI | 1437284726 |
---|---|
Provider Name | Dr. John Alec Liddy |
First Address | Woodland Hills, CA 91367-3110 |
Second Address | West Hollywood, CA 90048-1924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 24/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18342 | (02) | CA |