Provider Demographics
NPI:1952516502
Name:YAMAMOTO, PHILIP JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:YAMAMOTO
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 1:11752 GARDEN GROVE BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1461
Mailing Address - Country:US
Mailing Address - Phone:714-235-1000
Mailing Address - Fax:866-283-8968
Practice Address - Street 1:11752 GARDEN GROVE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1461
Practice Address - Country:US
Practice Address - Phone:714-235-1000
Practice Address - Fax:866-283-8968
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor