Provider Demographics
NPI:1780313957
Name:NOBORIKAWA, JACQUELINE MITSU (DC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MITSU
Last Name:NOBORIKAWA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 S BEACH BLVD UNIT G2054
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1681
Mailing Address - Country:US
Mailing Address - Phone:951-733-4509
Mailing Address - Fax:
Practice Address - Street 1:12225 SOUTH ST STE 105
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7046
Practice Address - Country:US
Practice Address - Phone:562-924-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68186225700000X
CADC36337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist