Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 111NR0400X | CA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 11NX0800X | CA |
NPI | 1528102704 |
---|---|
Provider Name | Dr. Moira Joanne Brannan |
First Address | San Diego, CA 92115-1621 |
Second Address | San Diego, CA 92115-1621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 03/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17023 | CA. STATE BOARD CHIROPRACTIC EXAMINERS (01) | CA |