Provider Demographics
NPI:1902932676
Name:KUWAMOTO, MARTIN KO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:KO
Last Name:KUWAMOTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 E GETTYSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0320
Mailing Address - Country:US
Mailing Address - Phone:559-222-2333
Mailing Address - Fax:559-222-2547
Practice Address - Street 1:2384 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0320
Practice Address - Country:US
Practice Address - Phone:559-222-2333
Practice Address - Fax:559-222-2547
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0124540Medicare ID - Type Unspecified