Provider Demographics
NPI:1518605807
Name:AKIYAMA, JUSTIN (DC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:AKIYAMA
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 1:7721 OWEN LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3830
Mailing Address - Country:US
Mailing Address - Phone:720-471-1394
Mailing Address - Fax:
Practice Address - Street 1:2501 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8021
Practice Address - Country:US
Practice Address - Phone:405-832-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9199111N00000X
OK4612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor