Healthcare Provider Details

I. General information

NPI: 1225717895
Provider Name (Legal Business Name): DILLON MASAKAZU MIZUKAMI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E TROPICANA AVE
LAS VEGAS NV
89119-6514
US

IV. Provider business mailing address

9309 YELLOWSHALE ST
LAS VEGAS NV
89143-1133
US

V. Phone/Fax

Practice location:
  • Phone: 725-247-1531
  • Fax:
Mailing address:
  • Phone: 310-748-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36508
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01983
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: