Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC17714 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | DC17714 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC17714 | CA |
N | 111NX0100X | Occupational Health | DC17714 | CA |
NPI | 1902946098 |
---|---|
Provider Name | Dr. Tyrone Lee Isquirdo |
First Address | Union City, CA 94587-2930 |
Second Address | Union City, CA 94587-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0177140 | (02) | CA |