Provider Demographics
NPI:1245244946
Name:ITO, TAKESHI (DC)
Entity Type:Individual
Prefix:
First Name:TAKESHI
Middle Name:
Last Name:ITO
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 1:24541 PACIFIC PARK DR STE 290
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3058
Mailing Address - Country:US
Mailing Address - Phone:949-448-8599
Mailing Address - Fax:949-448-8595
Practice Address - Street 1:24541 PACIFIC PARK DR STE 290
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3058
Practice Address - Country:US
Practice Address - Phone:949-448-8599
Practice Address - Fax:949-448-8595
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor