Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14175 | CA |
NPI | 1003032814 |
---|---|
Provider Name | Dr. Sandra Elizabeth Nystrom |
First Address | Redondo Beach, CA 90278-1405 |
Second Address | Redondo Beach, CA 90278-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |