Healthcare Provider Details

I. General information

NPI: 1003101858
Provider Name (Legal Business Name): AYAKO NAKANO CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E LIVE OAK AVE SUITE 200
ARCADIA CA
91006-5285
US

IV. Provider business mailing address

115 E LIVE OAK AVE SUITE 200
ARCADIA CA
91006-5285
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-1221
  • Fax: 626-446-1121
Mailing address:
  • Phone: 626-446-1221
  • Fax: 626-446-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11103
License Number StateCA

VIII. Authorized Official

Name: AYAKO NAKANO
Title or Position: PRESIDENT
Credential: D.C., LAC
Phone: 626-446-1221