Provider Demographics
NPI:1962615773
Name:POTTS, HAROLD EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EDWARD
Last Name:POTTS
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 1:10010 CALIFORNIA AVE.
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280
Mailing Address - Country:US
Mailing Address - Phone:562-234-6414
Mailing Address - Fax:323-567-2427
Practice Address - Street 1:10010 CALIFORNIA AVE.
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:562-234-6414
Practice Address - Fax:323-567-2427
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC018594111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician