Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 11292 | CA |
NPI | 1376577650 |
---|---|
Provider Name | Dr. Stanley M Cusak |
First Address | Fresno, CA 93720-2954 |
Second Address | Fresno, CA 93720-2954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |