Provider Demographics
NPI:1851953665
Name:SECORD, MILTON PAUL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:PAUL
Last Name:SECORD
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 W 172ND ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1106
Mailing Address - Country:US
Mailing Address - Phone:310-525-4193
Mailing Address - Fax:310-323-3133
Practice Address - Street 1:15406 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4524
Practice Address - Country:US
Practice Address - Phone:310-323-3133
Practice Address - Fax:310-323-3133
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor