Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 25792 | CA |
NPI | 1184861569 |
---|---|
Provider Name | Greg Rothstein |
First Address | Huntington Beach, CA 92615-6833 |
Second Address | Huntington Beach, CA 92646-6309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 07/01/2009 |