Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC25722 | CA |
N | 111NN1001X | Nutrition | DC25722 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC25722 | CA |
NPI | 1568487320 |
---|---|
Provider Name | Dr. Frank Erik Kaden |
First Address | Redondo Beach, CA 90278-1903 |
Second Address | Hermosa Beach, CA 90254-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 29/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20-2212128 | TAX IDENTIFICATION # (01) | CA |
DC0257220 | BLUE SHIELD PROVIDER # (01) | CA |