Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC22107 | CA |
NPI | 1417159419 |
---|---|
Provider Name | Dr. Lance Aaron O'connor |
First Address | Santa Rosa, CA 95403-3553 |
Second Address | Santa Rosa, CA 95403-3553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 04/06/2009 |