Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15563 | CA |
N | 111NI0013X | Independent Medical Examiner | 15563 | CA |
NPI | 1336352186 |
---|---|
Provider Name | John Wesley Daniels |
First Address | San Leandro, CA 94577-5147 |
Second Address | San Leandro, CA 94577-5147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 26/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T05818 | (02) | CA |