Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC18296 | CA |
NPI | 1316082589 |
---|---|
Provider Name | Dr. Michael Brandon Ackerman |
First Address | San Diego, CA 92110-3841 |
Second Address | La Jolla, CA 92037-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 20/10/2016 |