Provider Demographics
NPI:1518605807
Name:AKIYAMA, JUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:AKIYAMA
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 1:7701 E OSBORN RD APT 44W
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7418
Mailing Address - Country:US
Mailing Address - Phone:720-471-1394
Mailing Address - Fax:
Practice Address - Street 1:1855 E GUADALUPE RD STE 112
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3269
Practice Address - Country:US
Practice Address - Phone:877-222-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor