Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC26038 | CA |
NPI | 1245380385 |
---|---|
Provider Name | Ronald Stevens Cottrell |
First Address | Vista, CA 92081-5472 |
Second Address | Vista, CA 92081-5473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26038 | (02) | CA |