Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 11802 | CA |
NPI | 1447786074 |
---|---|
Provider Name | Mrs. Gail Penniman |
First Address | Soquel, CA 95073-2471 |
Second Address | Soquel, CA 95073-2471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2017 |
Last Update Date | 02/05/2017 |