Provider Demographics
NPI:1073601878
Name:YAMADA CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:YAMADA CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:YAMADA
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:562-860-3662
Mailing Address - Street 1:18331 GRIDLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5438
Mailing Address - Country:US
Mailing Address - Phone:562-860-3662
Mailing Address - Fax:562-860-4377
Practice Address - Street 1:18331 GRIDLEY RD STE C
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5438
Practice Address - Country:US
Practice Address - Phone:562-860-3662
Practice Address - Fax:562-860-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19337111N00000X
CAPT17984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20329OtherPTAN
CAW20329OtherPTAN
CAU32541Medicare PIN