Provider Demographics
NPI:1659459899
Name:IBA, YOJIRO (DC)
Entity type:Individual
Prefix:DR
First Name:YOJIRO
Middle Name:
Last Name:IBA
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 1:826 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2606
Mailing Address - Country:US
Mailing Address - Phone:831-757-8147
Mailing Address - Fax:831-757-4619
Practice Address - Street 1:826 E ALISAL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2606
Practice Address - Country:US
Practice Address - Phone:831-757-8147
Practice Address - Fax:831-757-4619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTDC18826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU32762Medicare UPIN