Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC0166810 | CA |
NPI | 1174562433 |
---|---|
Provider Name | Scott C Hale |
First Address | Placerville, CA 95667-8770 |
Second Address | Placerville, CA 95667-8770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0166810 | CHIROPRACTIC LICENCE # (01) | CA |
T06234 | (02) | CA |