Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 32718 | CA |
N | 111NP0017X | Pediatric Chiropractor | 32718 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 32718 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 32718 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 32718 | CA |
NPI | 1518392521 |
---|---|
Provider Name | Dr. Timothy Joshua Ursich |
First Address | Rancho Palos Verdes, CA 90275-0827 |
Second Address | Rancho Palos Verdes, CA 90275-0817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 22/06/2021 |