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General NPI Number Information
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NPI Number | 1184901506
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Entity Type | Organization
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Legal Business Name | SHIZEN CHIROPRACTIC AND ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 1821 WESTINGHOUSE RD STE 1160
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City | GEORGETOWN
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State | TX
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Zip | 78626-7645
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Country | US
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Telephone | 512-200-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 WESTINGHOUSE RD STE 1160
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City | GEORGETOWN
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State | TX
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Zip | 78626-7645
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Country | US
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Telephone | 512-200-7222
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | YUKO YAMAMOTO
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Credential | D.C., L.AC.
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Telephone | 512-200-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC30759
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 12500
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11636
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License Number State | TX
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