Healthcare Provider Details

I. General information

NPI: 1528073848
Provider Name (Legal Business Name): WAYNE EICHI HIGASHI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 SAWTELLE BLVD
LOS ANGELES CA
90066-1408
US

IV. Provider business mailing address

3030 SAWTELLE BLVD
LOS ANGELES CA
90066-1408
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-9018
  • Fax: 310-390-0868
Mailing address:
  • Phone: 310-390-9018
  • Fax: 310-390-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: