Provider Demographics
NPI:1528073848
Name:HIGASHI, WAYNE EICHI (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:EICHI
Last Name:HIGASHI
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 1:3030 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1408
Mailing Address - Country:US
Mailing Address - Phone:310-390-9018
Mailing Address - Fax:310-390-0868
Practice Address - Street 1:3030 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1408
Practice Address - Country:US
Practice Address - Phone:310-390-9018
Practice Address - Fax:310-390-0868
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07170Medicare UPIN
CACB259636Medicare PIN
CACB212984Medicare PIN