MEDICARE: CASEY S OKAMOTO DC

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	077861	IA

General Provider Information

NPI Number	:	1699141887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY S OKAMOTO DC

Provider Business Mailing Address
First Line	:	44 N PEARL ST APT 42
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1416
Country	:	US
Telephone Number	:	608-320-9104
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 N PEARL ST APT 42
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1416
Country	:	US
Telephone Number	:	608-320-9104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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Directions to “ CASEY S OKAMOTO DC” Practice Location

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