Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC31214 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 6455 | CO |
NPI | 1144462938 |
---|---|
Provider Name | Dr. Dustin Nabhan |
First Address | Colorado Springs, CO 80909-5780 |
Second Address | Colorado Springs, CO 80909-5780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2009 |
Last Update Date | 12/02/2010 |