Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 23553 | CA |
NPI | 1003989062 |
---|---|
Provider Name | Eric T. Matsuda |
First Address | Riverside, CA 92505-3673 |
Second Address | Riverside, CA 92505-3673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |