Provider Demographics
NPI:1740321116
Name:TSURUMOTO, ROGER (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:TSURUMOTO
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 1:10533 SAN PABLO AVE
Mailing Address - Street 2:SUITE A AND B
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530
Mailing Address - Country:US
Mailing Address - Phone:510-559-9555
Mailing Address - Fax:510-559-9522
Practice Address - Street 1:10533 SAN PABLO AVE
Practice Address - Street 2:SUITE A AND B
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2890
Practice Address - Country:US
Practice Address - Phone:510-559-9555
Practice Address - Fax:510-559-9522
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-25190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251900Medicare ID - Type UnspecifiedMEDICARE