Provider Demographics
NPI:1225164551
Name:KINO, SHINICHI (DC)
Entity Type:Individual
Prefix:DR
First Name:SHINICHI
Middle Name:
Last Name:KINO
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 1:1707 GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4469
Mailing Address - Country:US
Mailing Address - Phone:858-866-4545
Mailing Address - Fax:858-273-6702
Practice Address - Street 1:1707 GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4469
Practice Address - Country:US
Practice Address - Phone:858-866-4545
Practice Address - Fax:858-273-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor