Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14853 | CA |
NPI | 1003901448 |
---|---|
Provider Name | Dr. Kenneth Earl Lawver |
First Address | Manteca, CA 95336 |
Second Address | Manteca, CA 95336-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 18/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0148530 | (05) | CA |