Provider Demographics
NPI:1669529244
Name:IWASHITA, THOMAS Y (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:Y
Last Name:IWASHITA
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 1:11562 KNOTT ST STE 17
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-1823
Mailing Address - Country:US
Mailing Address - Phone:714-209-7602
Mailing Address - Fax:714-209-7465
Practice Address - Street 1:11562 KNOTT ST STE 17
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1823
Practice Address - Country:US
Practice Address - Phone:714-209-7602
Practice Address - Fax:714-209-7465
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U54864Medicare UPIN