Provider Demographics
NPI:1073737516
Name:NAKANO, STEPHEN KIYOSHI (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KIYOSHI
Last Name:NAKANO
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 1:1808 W 152ND ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4202
Mailing Address - Country:US
Mailing Address - Phone:310-323-3370
Mailing Address - Fax:310-323-0233
Practice Address - Street 1:1808 W 152ND ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4202
Practice Address - Country:US
Practice Address - Phone:310-323-3370
Practice Address - Fax:310-323-0233
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59578Medicare UPIN