MEDICARE: DR. MACK DAVID TOYAMA DC, PA-C

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	DC22187	CA
2	247200000X	Other Technician	RHC137145	CA
3	363A00000X	Physician Assistant	PA17044	CA

General Provider Information

NPI Number	:	1740235639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACK DAVID TOYAMA DC, PA-C

Provider Business Mailing Address
First Line	:	1901 HOLSER WALK
Second Line	:	#315
City	:	OXNARD
State	:	CA
Zip	:	93036-2633
Country	:	US
Telephone Number	:	805-988-2273
Fax Number	:	805-981-8281

Provider Business Practice Location Address
First Line	:	1901 HOLSER WALK
Second Line	:	#315
City	:	OXNARD
State	:	CA
Zip	:	93036-2633
Country	:	US
Telephone Number	:	805-988-2273
Fax Number	:	805-981-8281

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/21/2011

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