Healthcare Provider Details

I. General information

NPI: 1588740807
Provider Name (Legal Business Name): MICHIHIRO OKAZAKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 GIBBS DR SUITE 140
SAN DIEGO CA
92123-1747
US

IV. Provider business mailing address

8665 GIBBS DR SUITE 140
SAN DIEGO CA
92123-1747
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-8320
  • Fax: 858-514-8340
Mailing address:
  • Phone: 858-514-8320
  • Fax: 858-514-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: