Provider Demographics
NPI:1740348903
Name:SHIGEKAWA, GERALD KIYOSHI (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:KIYOSHI
Last Name:SHIGEKAWA
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 1:1415 JOANA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6948
Mailing Address - Country:US
Mailing Address - Phone:714-633-2923
Mailing Address - Fax:
Practice Address - Street 1:630 S GLASSELL ST STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3090
Practice Address - Country:US
Practice Address - Phone:714-633-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC733Medicare PIN