Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 12650 | CA |
Y | 111NN1001X | Nutrition | 12650 | CA |
NPI | 1649590274 |
---|---|
Provider Name | Dr. Roseann Dembeck |
First Address | Santa Monica, CA 90404-2756 |
Second Address | Santa Monica, CA 90404-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2010 |
Last Update Date | 05/06/2010 |