Provider Demographics
NPI:1548505852
Name:IKEDA, SUSUMU (DC)
Entity type:Individual
Prefix:
First Name:SUSUMU
Middle Name:
Last Name:IKEDA
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 1:8510 HILLCROFT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1018
Mailing Address - Country:US
Mailing Address - Phone:713-772-4607
Mailing Address - Fax:713-772-6015
Practice Address - Street 1:8510 HILLCROFT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096
Practice Address - Country:US
Practice Address - Phone:713-772-4607
Practice Address - Fax:713-772-6015
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor