Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC25869 | CA |
NPI | 1003944315 |
---|---|
Provider Name | Steven D Funk |
First Address | Irvine, CA 92618-2720 |
Second Address | Lincoln, CA 95648-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 11/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0258690 | BLUE SHIELD (01) | CA |
DC0258691 | BLUE SHIELD (01) | CA |
DC25869 | CHIROPRACTIC LICENSE (01) | CA |