MEDICARE: DR. GREGORY PAUL NISHIDA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC20722	CA

General Provider Information

NPI Number	:	1104957554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PAUL NISHIDA D.C.

Provider Business Mailing Address
First Line	:	20250 SW ACACIA ST
Second Line	:	SUITE #150
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1735
Country	:	US
Telephone Number	:	949-851-2225
Fax Number	:	949-851-2281

Provider Business Practice Location Address
First Line	:	20250 SW ACACIA ST
Second Line	:	SUITE #150
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1735
Country	:	US
Telephone Number	:	949-851-2225
Fax Number	:	949-851-2281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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