Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 111N00000X | CA |
N | 111NN0400X | Neurology | 111NN0400X | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 111NX0800X | CA |
NPI | 1053330795 |
---|---|
Provider Name | Paul J Davis |
First Address | Anaheim, CA 92805-5622 |
Second Address | Anaheim, CA 92805-5622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
EH5352 | (02) | CA |