Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC13319 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | DC13319 | CA |
N | 111NX0100X | Occupational Health | DC13319 | CA |
NPI | 1104941434 |
---|---|
Provider Name | Dr. Robert George |
First Address | La Jolla, CA 92037-4313 |
Second Address | La Jolla, CA 92037-4313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0133190 | BLUE SHIELD (01) | CA |
DC13319 | STATE LICENSE (01) | CA |