Provider Demographics
NPI:1679740856
Name:GASPER, PAUL (D C)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:GASPER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E DYER RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5740
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:
Practice Address - Street 1:29229 CANWOOD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1561
Practice Address - Country:US
Practice Address - Phone:310-649-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20593OtherLICENSE