Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC27721 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | DC27721 | CA |
NPI | 1275607715 |
---|---|
Provider Name | Dr. Todd R Bedell |
First Address | San Jose, CA 95126-1131 |
Second Address | San Jose, CA 95126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 23/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08570 | (02) | CA |