Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC161210 | CA |
N | 111NN0400X | Neurology | DC16121 | CA |
N | 111NN1001X | Nutrition | DC16121 | CA |
N | 111NR0200X | Radiology | DC16121 | CA |
N | 213ER0200X | Radiology | DC16121 | CA |
NPI | 1699885608 |
---|---|
Provider Name | Mr. Gregory Ray Heyart |
First Address | Bakersfield, CA 93309 |
Second Address | Bakersfield, CA 93309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 31/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0161210 | (02) | CA |