Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33391 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 33391 | CA |
NPI | 1316318702 |
---|---|
Provider Name | Dr. Maveric Hartwell |
First Address | Ojai, CA 93023-4134 |
Second Address | Ojai, CA 93023-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2015 |
Last Update Date | 14/11/2018 |