Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC24513 | CA |
NPI | 1144520040 |
---|---|
Provider Name | Dr. Julian Lansing Mines IV |
First Address | San Clemente, CA 92673-6914 |
Second Address | San Clemente, CA 92672-5540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 02/11/2010 |