Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 34853 | CA |
NPI | 1003416264 |
---|---|
Provider Name | Lance Usherenko |
First Address | Beverly Hills, CA 90209-5274 |
Second Address | Van Nuys, CA 91411-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 09/11/2020 |