Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 31737 | CA |
NPI | 1164725719 |
---|---|
Provider Name | Dr. Michael Lord |
First Address | San Francisco, CA 94123-3807 |
Second Address | San Francisco, CA 94123-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2010 |
Last Update Date | 02/11/2012 |