Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 28648 | CA |
NPI | 1174629851 |
---|---|
Provider Name | Dr. Laurent Lewis Colvin |
First Address | Davis, CA 95616-4395 |
Second Address | Davis, CA 95616-4395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |