Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 14672 | CA |
NPI | 1760611768 |
---|---|
Provider Name | Dr. John Smith Krage |
First Address | San Diego, CA 92108-1302 |
Second Address | San Diego, CA 92108-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2009 |
Last Update Date | 11/07/2009 |