Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 19377 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 19377 | CA |
NPI | 1093890691 |
---|---|
Provider Name | Roderick J. Bazil |
First Address | Huntington Beach, CA 92648-1707 |
Second Address | Huntington Beach, CA 92648-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 24/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T82732 | (02) | CA |