Provider Demographics
NPI:1063631422
Name:ADACHI, MARK MICHIO (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:MICHIO
Last Name:ADACHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 N CENTRAL AVE #325
Mailing Address - Street 2:#325
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2055
Mailing Address - Country:US
Mailing Address - Phone:818-243-4353
Mailing Address - Fax:818-240-5245
Practice Address - Street 1:411 N CENTRAL AVE #325
Practice Address - Street 2:#325
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2055
Practice Address - Country:US
Practice Address - Phone:818-243-4353
Practice Address - Fax:818-240-5245
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor