Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 19133 | CA |
N | 111NN1001X | Nutrition | 19133 | CA |
NPI | 1588710263 |
---|---|
Provider Name | Dr. Bradley C Shapero |
First Address | San Clemente, CA 92673-6957 |
Second Address | San Clemente, CA 92673-6310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 13/12/2016 |