Healthcare Provider Details

I. General information

NPI: 1073635413
Provider Name (Legal Business Name): MASAHIRO TAKAKURA ND, LAC, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7621 AURORA AVE N
SEATTLE WA
98103-4749
US

IV. Provider business mailing address

7621 AURORA AVE N
SEATTLE WA
98103-4749
US

V. Phone/Fax

Practice location:
  • Phone: 206-588-1061
  • Fax: 206-297-6118
Mailing address:
  • Phone: 206-588-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00034639
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2275
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1222
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: