Healthcare Provider Details

I. General information

NPI: 1255366787
Provider Name (Legal Business Name): KUWABARA CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W CENTRAL AVE STE B
BREA CA
92821-3001
US

IV. Provider business mailing address

279 ALBERT PL
COSTA MESA CA
92627-1813
US

V. Phone/Fax

Practice location:
  • Phone: 714-255-8343
  • Fax: 714-255-8314
Mailing address:
  • Phone: 714-343-8085
  • Fax: 714-255-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberDC20273
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN J KUWABARA
Title or Position: OWNER
Credential: D.C.
Phone: 714-343-8085