Provider Demographics
NPI:1255366787
Name:KUWABARA CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:KUWABARA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUWABARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-343-8085
Mailing Address - Street 1:279 ALBERT PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1813
Mailing Address - Country:US
Mailing Address - Phone:714-343-8085
Mailing Address - Fax:714-255-8314
Practice Address - Street 1:420 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3001
Practice Address - Country:US
Practice Address - Phone:714-255-8343
Practice Address - Fax:714-255-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20273261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386645067OtherNPI
CAU42188Medicare UPIN