Provider Demographics
NPI:1780783225
Name:IKEDA, DAVID W (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:IKEDA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23659 COLUMBUS RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1979
Mailing Address - Country:US
Mailing Address - Phone:609-298-7700
Mailing Address - Fax:609-298-7724
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1979
Practice Address - Country:US
Practice Address - Phone:609-298-7700
Practice Address - Fax:609-298-7724
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00530400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0206318850OtherHORIZON BLUE CROSS/SHIELD
NJ3343106OtherAETNA
NJ2269303000OtherAMERIHEALTH
NJ3343106OtherAETNA