Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33698 | CA |
NPI | 1003328774 |
---|---|
Provider Name | Mr. Fred George Seyfried |
First Address | San Diego, CA 92121 |
Second Address | San Diego, CA 92121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 02/11/2017 |