Provider Demographics
NPI:1548349277
Name:YAMADA, NORIHIRO (DC)
Entity type:Individual
Prefix:DR
First Name:NORIHIRO
Middle Name:
Last Name:YAMADA
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 1:116 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2049
Mailing Address - Country:US
Mailing Address - Phone:630-307-1150
Mailing Address - Fax:630-307-1150
Practice Address - Street 1:116 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2049
Practice Address - Country:US
Practice Address - Phone:630-307-1150
Practice Address - Fax:630-307-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232770OtherBLUE CROSS BLUE SHIELD
IL02232770OtherBLUE CROSS BLUE SHIELD