Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC12564 | CA |
NPI | 1053590794 |
---|---|
Provider Name | Mr. Tim G Ursich |
First Address | Rancho Palos Verdes, CA 90275-0817 |
Second Address | Rancho Palos Verdes, CA 90275-0817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 09/12/2020 |