Provider Demographics
NPI:1417286741
Name:NAKAMURA, KAZUKO (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KAZUKO
Middle Name:
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2835
Mailing Address - Country:US
Mailing Address - Phone:203-220-8923
Mailing Address - Fax:866-509-3588
Practice Address - Street 1:115 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1662
Practice Address - Country:US
Practice Address - Phone:203-220-8923
Practice Address - Fax:866-509-3588
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004421171100000X
CT430175F00000X
CT869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath