Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 26273 | CA |
NPI | 1003903410 |
---|---|
Provider Name | Ian Chambers |
First Address | Santa Cruz, CA 95060-2760 |
Second Address | Santa Cruz, CA 95060-2760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |