Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC22727 | CA |
NPI | 1124079397 |
---|---|
Provider Name | Dr. Rikke Johansen |
First Address | Palo Alto, CA 94301-1719 |
Second Address | Palo Alto, CA 94301-1748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50305 | (02) | CA |