Provider Demographics
NPI:1013992841
Name:PAUL EDWARD OKAMOTO
Entity Type:Organization
Organization Name:PAUL EDWARD OKAMOTO
Other - Org Name:MASTER'S TOUCH CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:OKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-224-2225
Mailing Address - Street 1:1730 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4038
Mailing Address - Country:US
Mailing Address - Phone:503-224-2225
Mailing Address - Fax:503-222-3883
Practice Address - Street 1:1730 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4038
Practice Address - Country:US
Practice Address - Phone:503-224-2225
Practice Address - Fax:503-222-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103539Medicare ID - Type Unspecified