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NPI Code Detail

MEDICARE: DR. DAIKI ISHIYAMA D.C.

MEDICARE: DR. DAIKI ISHIYAMA D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038011946IL

General Provider Information

NPI Number : 1053700336
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAIKI ISHIYAMA D.C.
Provider Business Mailing Address
First Line : 2565 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-6725
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2565 SHERMER RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-6725
Country : US
Telephone Number : 847-272-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2015
Last Update Date : 01/09/2015

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