Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 20736 | CA |
N | 111NN0400X | Neurology | 20736 | CA |
N | 111NN1001X | Nutrition | 20736 | CA |
N | 111NR0200X | Radiology | 20736 | CA |
N | 213ER0200X | Radiology | 20736 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 20736 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 20736 | CA |
N | 111NX0100X | Occupational Health | 20736 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 20736 | CA |
NPI | 1316274335 |
---|---|
Provider Name | Dr. Michael C Parillo |
First Address | Riverside, CA 92506-3943 |
Second Address | Riverside, CA 92506-3943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2009 |
Last Update Date | 11/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZZ51118Y | BLUE SHIELD (01) | CA |