Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC27396 | CA |
NPI | 1073544979 |
---|---|
Provider Name | Dr. Nicolas Campos |
First Address | West Hollywood, CA 90046-6103 |
Second Address | West Hollywood, CA 90046-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 30/11/2021 |