Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 34782 | CA |
N | 111NI0013X | Independent Medical Examiner | 35782 | CA |
N | 111NX0100X | Occupational Health | 34782 | CA |
NPI | 1770180895 |
---|---|
Provider Name | Mark Allen O'brien |
First Address | El Dorado Hills, CA 95762-4003 |
Second Address | El Dorado Hills, CA 95762-3927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |