Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC24364 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | DC24364 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC24364 | CA |
NPI | 1407841836 |
---|---|
Provider Name | Dr. Manuel M Fonseca |
First Address | San Francisco, CA 94110-2582 |
Second Address | San Francisco, CA 94110-2474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0243640 | (02) | CA |
DC0243640 | (05) | CA |