Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 19846 | CA |
NPI | 1245345925 |
---|---|
Provider Name | Dr. Stephen Dale Iversen |
First Address | Orange, CA 92867-5248 |
Second Address | Orange, CA 92867-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC019846 | (02) | CA |