Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC20722 | CA |
NPI | 1104957554 |
---|---|
Provider Name | Dr. Gregory Paul Nishida |
First Address | Newport Beach, CA 92660-1735 |
Second Address | Newport Beach, CA 92660-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01157 | (02) | CA |