Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 27638 | CA |
NPI | 1023281235 |
---|---|
Provider Name | Lisa Schaefer |
First Address | Santa Ana, CA 92799-5971 |
Second Address | Fountain Valley, CA 92708-3232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 13/03/2012 |