Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC15369 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC15369 | CA |
NPI | 1033140348 |
---|---|
Provider Name | Michael W. Roquemore |
First Address | Torrance, CA 90505-3729 |
Second Address | Torrance, CA 90505-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033140348 | (02) | CA |