Provider Demographics
NPI:1821172149
Name:IKEDA, CLIFF KAZUO (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:KAZUO
Last Name:IKEDA
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 1:17625 CRENSHAW BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3458
Mailing Address - Country:US
Mailing Address - Phone:310-771-0881
Mailing Address - Fax:310-771-0883
Practice Address - Street 1:17625 CRENSHAW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3458
Practice Address - Country:US
Practice Address - Phone:310-771-0881
Practice Address - Fax:310-771-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGE377ZMedicare PIN
CAU87567Medicare UPIN