Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 20723 | CA |
NPI | 1386717494 |
---|---|
Provider Name | Dr. Glenn C Nusbaum |
First Address | San Diego, CA 92108-1313 |
Second Address | San Diego, CA 92108-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U36742 | (02) | CA |