1639298557 NPI number — RANDY S. HIGASHI CHIROPRACTIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639298557 NPI number — RANDY S. HIGASHI CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDY S. HIGASHI CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639298557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13502 WHITTER BLVD.
Provider Second Line Business Mailing Address:
SUITE H, #507
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90605-1944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-546-3500
Provider Business Mailing Address Fax Number:
323-638-1253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3621 MARTIN LUTHER KING JR. BLVD.
Provider Second Line Business Practice Location Address:
SUITE # 14
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-546-3500
Provider Business Practice Location Address Fax Number:
323-638-1253
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HIGASHI
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
323-546-3500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC26404 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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