Healthcare Provider Details

I. General information

NPI: 1861984197
Provider Name (Legal Business Name): IWASHITA CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11562 KNOTT ST STE 17
GARDEN GROVE CA
92841-1823
US

IV. Provider business mailing address

11562 KNOTT ST STE 17
GARDEN GROVE CA
92841-1823
US

V. Phone/Fax

Practice location:
  • Phone: 714-209-7602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27090
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS Y IWASHITA
Title or Position: CEO
Credential: DC
Phone: 714-209-7602