Provider Demographics
NPI:1902831845
Name:YAMADA, JON R (DC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:R
Last Name:YAMADA
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 1:18331 GRIDLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5438
Mailing Address - Country:US
Mailing Address - Phone:562-860-3662
Mailing Address - Fax:562-860-4377
Practice Address - Street 1:18331 GRIDLEY RD STE C
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5438
Practice Address - Country:US
Practice Address - Phone:562-860-3662
Practice Address - Fax:562-860-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20329Medicare UPIN
CAU32541Medicare UPIN