Provider Demographics
NPI:1134512809
Name:TANAKA, JOSUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSUKE
Middle Name:
Last Name:TANAKA
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 1:95-745 LAUAKI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2909
Mailing Address - Country:US
Mailing Address - Phone:310-895-4887
Mailing Address - Fax:
Practice Address - Street 1:95-745 LAUAKI ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2909
Practice Address - Country:US
Practice Address - Phone:310-895-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33185111NN0400X
HIDC-1422111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology