Provider Demographics
NPI:1710006499
Name:HIGASHIDA, ROLEN SUNAO III (DC)
Entity Type:Individual
Prefix:DR
First Name:ROLEN
Middle Name:SUNAO
Last Name:HIGASHIDA
Suffix:III
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 1:21127 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2828
Mailing Address - Country:US
Mailing Address - Phone:818-704-7647
Mailing Address - Fax:818-704-7649
Practice Address - Street 1:21127 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2828
Practice Address - Country:US
Practice Address - Phone:818-704-7647
Practice Address - Fax:818-704-7649
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15238DCMedicare ID - Type Unspecified