Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 22001 | CA |
NPI | 1316231236 |
---|---|
Provider Name | Mark Andrew Heslip |
First Address | San Francisco, CA 94104-3327 |
Second Address | San Francisco, CA 94104-3327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 08/06/2011 |