Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 33985 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 33985 | CA |
N | 111NX0100X | Occupational Health | 33985 | CA |
NPI | 1831614379 |
---|---|
Provider Name | Tyler Jones |
First Address | Laguna Hills, CA 92653-5507 |
Second Address | Laguna Hills, CA 92653-5507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2017 |
Last Update Date | 05/08/2017 |