Provider Demographics
NPI:1497895031
Name:TAKITANI, TY KENJI (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:KENJI
Last Name:TAKITANI
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 1:3180 COLIMA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6315
Mailing Address - Country:US
Mailing Address - Phone:626-369-7077
Mailing Address - Fax:626-369-0175
Practice Address - Street 1:3180 COLIMA RD
Practice Address - Street 2:SUITE A
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6315
Practice Address - Country:US
Practice Address - Phone:626-369-7077
Practice Address - Fax:626-369-0175
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor