Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC23550 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | DC23550 | CA |
NPI | 1396900304 |
---|---|
Provider Name | Dr. Raoul Micheal Magana |
First Address | Lodi, CA 95242-4336 |
Second Address | Lodi, CA 95242-4336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2008 |
Last Update Date | 20/07/2008 |