MEDICARE: KOJI UEMURA D.C., L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15056	CA
2	171100000X	Acupuncturist	AC821	CA

General Provider Information

NPI Number	:	1033295118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOJI UEMURA D.C., L.AC.

Provider Business Mailing Address
First Line	:	2340 SEPULVEDA BLVD
Second Line	:	#A
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:	310-539-6633
Fax Number	:	310-539-6632

Provider Business Practice Location Address
First Line	:	2340 SEPULVEDA BLVD
Second Line	:	#A
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:	310-539-6633
Fax Number	:	310-539-6632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/16/2016

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