Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC28278 | CA |
NPI | 1356557920 |
---|---|
Provider Name | Jeffrey Randall Potts |
First Address | San Jose, CA 95124-5342 |
Second Address | San Jose, CA 95124-5342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 09/09/2010 |