Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 17019 | CA |
NPI | 1003831546 |
---|---|
Provider Name | Karen Marie Borges |
First Address | South Lake Tahoe, CA 96150-6408 |
Second Address | South Lake Tahoe, CA 96150-6408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0170190 | BLUE CROSS PIN (01) | CA |
T90342 | (02) | CA |