Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 23228 | CA |
N | 111N00000X | Chiropractor | C000021 | GU |
NPI | 1003251182 |
---|---|
Provider Name | William John Cogan |
First Address | Manhattan Beach, CA 90266-3148 |
Second Address | Manhattan Beach, CA 90266-3148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 02/05/2013 |