Provider Demographics
NPI:1033295118
Name:UEMURA, KOJI (DC, LAC)
Entity Type:Individual
Prefix:
First Name:KOJI
Middle Name:
Last Name:UEMURA
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 SEPULVEDA BLVD
Mailing Address - Street 2:#A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4331
Mailing Address - Country:US
Mailing Address - Phone:310-539-6633
Mailing Address - Fax:310-539-6632
Practice Address - Street 1:2340 SEPULVEDA BLVD
Practice Address - Street 2:#A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4331
Practice Address - Country:US
Practice Address - Phone:310-539-6633
Practice Address - Fax:310-539-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15056111N00000X
CAAC821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist