Provider Demographics
NPI:1083727150
Name:TAO, MICHINORI (DC)
Entity Type:Individual
Prefix:
First Name:MICHINORI
Middle Name:
Last Name:TAO
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 1:484 MOBIL AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6303
Mailing Address - Country:US
Mailing Address - Phone:805-384-2363
Mailing Address - Fax:805-384-2364
Practice Address - Street 1:484 MOBIL AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6303
Practice Address - Country:US
Practice Address - Phone:805-384-2363
Practice Address - Fax:805-384-2364
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17905Medicare ID - Type Unspecified
T06585Medicare UPIN