Provider Demographics
NPI:1952433989
Name:YANAGITA, MICHAEL KAZUO (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KAZUO
Last Name:YANAGITA
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 SANTA BARBARA AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2341
Mailing Address - Country:US
Mailing Address - Phone:818-468-7934
Mailing Address - Fax:
Practice Address - Street 1:1640 SANTA BARBARA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2021
Practice Address - Country:US
Practice Address - Phone:181-846-8793
Practice Address - Fax:818-506-7674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15443111N00000X
CAAC 6680171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15443OtherOTHER INSURANCE CO.