Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC26350 | CA |
NPI | 1003843186 |
---|---|
Provider Name | Dr. Roger David Brousseau |
First Address | Elk Grove, CA 95758-1141 |
Second Address | Sacramento, CA 95823-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |