Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC31552 | CA |
NPI | 1114280799 |
---|---|
Provider Name | Dr. Justin James Grasmeyer |
First Address | Bellflower, CA 90706-7126 |
Second Address | Bellflower, CA 90706-7126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 19/06/2012 |