Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 30570 | CA |
NPI | 1003019373 |
---|---|
Provider Name | Nicholas D. Kousoulis |
First Address | Los Angeles, CA 90024-2903 |
Second Address | Los Angeles, CA 90024-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 03/02/2009 |