Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 20076 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 20076 | CA |
NPI | 1225119233 |
---|---|
Provider Name | Dr. Lawrence Dieter |
First Address | San Luis Obispo, CA 93406-5858 |
Second Address | San Luis Obispo, CA 93401-3308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 30/11/2015 |