Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC33008 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | DC33008 | CA |
NPI | 1265821672 |
---|---|
Provider Name | Dr. Khaleed Samuels |
First Address | San Pedro, CA 90732-1204 |
Second Address | San Pedro, CA 90732-3803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 27/08/2019 |