Provider Demographics
NPI:1801147079
Name:MAI, LOC (DC)
Entity type:Individual
Prefix:DR
First Name:LOC
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 E KINGS CANYON RD
Mailing Address - Street 2:#103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3837
Mailing Address - Country:US
Mailing Address - Phone:559-273-7247
Mailing Address - Fax:
Practice Address - Street 1:4842 E KINGS CANYON RD
Practice Address - Street 2:#103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3837
Practice Address - Country:US
Practice Address - Phone:559-273-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor