Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC21808 | CA |
NPI | 1013034263 |
---|---|
Provider Name | Dr. Sally Smithern |
First Address | Los Angeles, CA 90025 |
Second Address | Venice, CA 90291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |