Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 34192 | CA |
NPI | 1093206799 |
---|---|
Provider Name | Dr. Nathan Marshall |
First Address | San Diego, CA 92117-6917 |
Second Address | San Diego, CA 92117-6917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |