MEDICARE: KOJI UEMURA CHIROPRACTIC, INC.

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	111N00000X	Chiropractor	15056
2	171100000X	Acupuncturist	AC821

General Provider Information

NPI Number	:	1598212557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOJI UEMURA CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	2340 SEPULVEDA BLVD
Second Line	:	#A
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:	310-539-6633
Fax Number	:	310-539-6632

Provider Business Practice Location Address
First Line	:	2340 SEPULVEDA BLVD
Second Line	:	#A
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:	310-539-6633
Fax Number	:	310-539-6632

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KOJI UEMURA
Credential	:
Telephone Number	:	310-539-6633

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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