Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH00034639 | WA |
Y | 175F00000X | Naturopath | NT1222 | WA |
NPI | 1073635413 |
---|---|
Provider Name | Masahiro Takakura |
First Address | Seattle, WA 98103-4749 |
Second Address | Seattle, WA 98103-4749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 08/12/2011 |