Provider Demographics
NPI:1780982462
Name:IKEDA CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:IKEDA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:KAZUO
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-771-0881
Mailing Address - Street 1:17625 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3452
Mailing Address - Country:US
Mailing Address - Phone:310-771-0881
Mailing Address - Fax:310-771-0883
Practice Address - Street 1:17625 CRENSHAW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3452
Practice Address - Country:US
Practice Address - Phone:310-771-0881
Practice Address - Fax:310-771-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87567Medicare UPIN