Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 34516 | CA |
N | 111NN1001X | Nutrition | 34516 | CA |
N | 111NX0100X | Occupational Health | 34516 | CA |
NPI | 1386222164 |
---|---|
Provider Name | Dr. Tage Sebastian Kverneland |
First Address | Los Angeles, CA 90004-3951 |
Second Address | Los Angeles, CA 90038-3341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2021 |
Last Update Date | 31/03/2021 |