Provider Demographics
NPI:1366491144
Name:AKITA, BYRON (DC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:AKITA
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 1:1806 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1147
Mailing Address - Country:US
Mailing Address - Phone:541-296-1976
Mailing Address - Fax:
Practice Address - Street 1:818 W 6TH ST SUITE 5
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1147
Practice Address - Country:US
Practice Address - Phone:541-296-1900
Practice Address - Fax:541-298-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGDVKMedicare ID - Type Unspecified
ORT67384Medicare UPIN