Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 14556 | CA |
NPI | 1396885893 |
---|---|
Provider Name | Dr. Michael Blott |
First Address | Poway, CA 92064-2147 |
Second Address | Poway, CA 92064-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC14556 | (02) | CA |