Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC17738 | CA |
NPI | 1013007186 |
---|---|
Provider Name | Jeffrey Levine |
First Address | Irvine, CA 92618-6705 |
Second Address | San Jose, CA 95117-1047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0177380 | BLUE SHIELD (01) | CA |
T06552 | (02) | CA |