Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC10682 | CA |
NPI | 1003958877 |
---|---|
Provider Name | Dr. Vincent P Savarese |
First Address | Twentynine Palms, CA 92277-2459 |
Second Address | Twentynine Palms, CA 92277-2459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T16952 | (02) | CA |