Provider Demographics
NPI:1891180790
Name:NIETO, AUGUSTINE LOUIS III (DC)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:LOUIS
Last Name:NIETO
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4200 TRABUCO RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3600
Mailing Address - Country:US
Mailing Address - Phone:949-552-1172
Mailing Address - Fax:949-552-8172
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3600
Practice Address - Country:US
Practice Address - Phone:949-552-1172
Practice Address - Fax:949-552-8172
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC33247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC33247OtherSTATE OF CALIFORNIA BOARD OF CHIROPRACTIC EXAMINERS