Healthcare Provider Details

I. General information

NPI: 1073601878
Provider Name (Legal Business Name): YAMADA CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18331 GRIDLEY RD STE C
CERRITOS CA
90703-5438
US

IV. Provider business mailing address

18331 GRIDLEY RD STE C
CERRITOS CA
90703-5438
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-3662
  • Fax: 562-860-4377
Mailing address:
  • Phone: 562-860-3662
  • Fax: 562-860-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19337
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17984
License Number StateCA

VIII. Authorized Official

Name: DR. JON R YAMADA IV
Title or Position: OWNER
Credential: D.C.
Phone: 562-860-3662