Provider Demographics
NPI:1740211895
Name:ITO, STEPHEN MITSURU (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MITSURU
Last Name:ITO
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 1:29280 MOON HILL CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7315
Mailing Address - Country:US
Mailing Address - Phone:951-679-7874
Mailing Address - Fax:
Practice Address - Street 1:39525 LOS ALAMOS RD
Practice Address - Street 2:SUITE E
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5027
Practice Address - Country:US
Practice Address - Phone:951-698-4032
Practice Address - Fax:951-698-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor