MEDICARE: YAMAMOTO 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	DC29270	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	$$$$$$$$$	OTHER	CA	SOCIAL SECURITY NUMBER
2	DC29270	OTHER	CA	CHIROPRACTIC LIC NUMBER

General Provider Information

NPI Number	:	1952423360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAMAMOTO CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	SUITE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4028
Country	:	US
Telephone Number	:	619-584-8490
Fax Number	:	619-584-8101

Provider Business Practice Location Address
First Line	:	5995 MISSION GORGE RD
Second Line	:	SUITE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4028
Country	:	US
Telephone Number	:	619-584-8490
Fax Number	:	619-584-8101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARL ALAN YAMAMOTO
Credential	:	DC
Telephone Number	:	619-584-8490

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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Directions to “YAMAMOTO CHIROPRACTIC, INC. ” Practice Location

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