Provider Demographics
NPI:1265889315
Name:TAKAOKA, MIEKO (LAC, MSAOM, DAOM)
Entity type:Individual
Prefix:
First Name:MIEKO
Middle Name:
Last Name:TAKAOKA
Suffix:
Gender:F
Credentials:LAC, MSAOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CROSS POINTE RD STE H
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6692
Mailing Address - Country:US
Mailing Address - Phone:614-626-3058
Mailing Address - Fax:614-626-3268
Practice Address - Street 1:750 CROSS POINTE RD STE H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6692
Practice Address - Country:US
Practice Address - Phone:614-626-3058
Practice Address - Fax:614-626-3268
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH66.000067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist