Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 31097 | CA |
N | 111NP0017X | Pediatric Chiropractor | 31097 | CA |
NPI | 1033526207 |
---|---|
Provider Name | Dr. Joshua Welch |
First Address | Irvine, CA 92618-6705 |
Second Address | South Lake Tahoe, CA 96150-8478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2014 |
Last Update Date | 03/11/2015 |