Provider Demographics
NPI:1497086987
Name:NAKASEKO, TAKANOBU (DC)
Entity Type:Individual
Prefix:DR
First Name:TAKANOBU
Middle Name:
Last Name:NAKASEKO
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 1:707 W SHERIDAN RD APT 316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3205
Mailing Address - Country:US
Mailing Address - Phone:563-940-4555
Mailing Address - Fax:
Practice Address - Street 1:1165 N CLARK ST STE 602
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7848
Practice Address - Country:US
Practice Address - Phone:312-787-7222
Practice Address - Fax:312-787-7227
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011585390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program