Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NP0017X | Pediatric Chiropractor | DC-31196 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | DC-31196 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC-31196 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC-31196 | CA |
NPI | 1952538514 |
---|---|
Provider Name | Dr. Kelly Ann Tomasulo |
First Address | Lancaster, CA 93534-2819 |
Second Address | Lancaster, CA 93534-2819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 18/02/2013 |