Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 16046 | CA |
NPI | 1356392450 |
---|---|
Provider Name | Trevor D Sanks |
First Address | El Cajon, CA 92021-4804 |
Second Address | El Cajon, CA 92021-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 08/07/2007 |