Provider Demographics
NPI:1093076127
Name:ICHIMASA, BREE MISAKO (DC)
Entity Type:Individual
Prefix:DR
First Name:BREE
Middle Name:MISAKO
Last Name:ICHIMASA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 ULUPUA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4744
Mailing Address - Country:US
Mailing Address - Phone:808-732-1557
Mailing Address - Fax:
Practice Address - Street 1:45-1048 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3241
Practice Address - Country:US
Practice Address - Phone:808-247-4842
Practice Address - Fax:808-247-4842
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor