Provider Demographics
NPI:1073635413
Name:TAKAKURA, MASAHIRO (ND, LAC, DC)
Entity Type:Individual
Prefix:
First Name:MASAHIRO
Middle Name:
Last Name:TAKAKURA
Suffix:
Gender:M
Credentials:ND, LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4749
Mailing Address - Country:US
Mailing Address - Phone:206-588-1061
Mailing Address - Fax:
Practice Address - Street 1:7621 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4749
Practice Address - Country:US
Practice Address - Phone:206-588-1061
Practice Address - Fax:206-297-6118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034639111NX0800X
WAAC2275171100000X
WANT1222175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No171100000XOther Service ProvidersAcupuncturist