Doctor Name: | DR. LORANE MITTIE DICK |
NPI Number: | 1174554927 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 20A4508 |
Business Practice Address: | 554 E Foothill Blvd Ste. 120 San Dimas, CA - 917731222 |
Business Phone Number: | 9095928399 |
Business Fax Number: | 9095928399 |
Mailing Address: | 554 E Foothill Blvd, Ste. 120 SAN DIMAS |
State: | CA |
Postal Code: | 917731222 |
Phone Number: | 9095928399 |
Fax Number: | 9095928399 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 05/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 20A4508 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |