Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | DC-30965 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC-30965 | CA |
NPI | 1215182050 |
---|---|
Provider Name | Dr. Martine Romi Wayne |
First Address | Laguna Beach, CA 92651-2970 |
Second Address | Laguna Beach, CA 92651-2970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |