Provider Demographics
NPI:1073506093
Name:YAMAMOTO, CARL ALAN (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ALAN
Last Name:YAMAMOTO
Suffix:
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 1:5995 MISSION GORGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4028
Mailing Address - Country:US
Mailing Address - Phone:619-584-8490
Mailing Address - Fax:619-584-8101
Practice Address - Street 1:5995 MISSION GORGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4028
Practice Address - Country:US
Practice Address - Phone:619-584-8490
Practice Address - Fax:619-584-8101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0292700OtherBLUE SHIELD PROVIDER #
CADC0292700OtherBLUE SHIELD PROVIDER #
CADC29270Medicare PIN