| NPI | 1043370265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL M. FONSECA Director 415-695-0654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC24364) |
| Additional Taxonomies | 111NR0400X (Licence: CA DC24364) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA DC24364) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |