Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 34065 | CA |
NPI | 1003329137 |
---|---|
Provider Name | Tracy Lam |
First Address | Alhambra, CA 91801 |
Second Address | Alhambra, CA 91801-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2017 |
Last Update Date | 19/11/2020 |