Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC14692 | CA |
NPI | 1417045253 |
---|---|
Provider Name | William Charles Mckean |
First Address | Roseville, CA 95678-2712 |
Second Address | Roseville, CA 95678-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |