MEDICARE: TAKAHASHI CHIROPRACTIC CO.

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
1	111NR0400X	Rehabilitation Chiropractor	DC25299	CA

General Provider Information

NPI Number	:	1326308198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKAHASHI CHIROPRACTIC CO.

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD STE 340
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1613
Country	:	US
Telephone Number	:	310-445-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD STE 340
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1613
Country	:	US
Telephone Number	:	310-445-1050
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRANDON DAVID TAKAHASHI
Credential	:	D.C.
Telephone Number	:	310-445-1050

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/25/2012

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