Provider Demographics
NPI:1437181658
Name:TAKAGI, ANDY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:TAKAGI
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 1:1506 BROOKHOLLOW DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5405
Mailing Address - Country:US
Mailing Address - Phone:714-957-0111
Mailing Address - Fax:
Practice Address - Street 1:1506 BROOKHOLLOW DR
Practice Address - Street 2:SUITE 114
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5405
Practice Address - Country:US
Practice Address - Phone:714-957-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC 946111N00000X
CADC 28744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55418Medicare ID - Type Unspecified
U94898Medicare UPIN