Provider Demographics
NPI:1760446355
Name:IWO, HARUO (DC)
Entity Type:Individual
Prefix:DR
First Name:HARUO
Middle Name:
Last Name:IWO
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 1:10092 CHAPMAN AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840
Mailing Address - Country:US
Mailing Address - Phone:714-638-2210
Mailing Address - Fax:
Practice Address - Street 1:10092 CHAPMAN AVE
Practice Address - Street 2:STE 5
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840
Practice Address - Country:US
Practice Address - Phone:714-638-2210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC9998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T19055Medicare UPIN
CADC9998Medicare ID - Type Unspecified