Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 19532 | CA |
NPI | 1447331202 |
---|---|
Provider Name | Dr. John Rossall Maynes |
First Address | Vista, CA 92084-6066 |
Second Address | Vista, CA 92084-6066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC19532 | CALIFORNIA D.C. LICENSE # (01) | CA |