Provider Demographics
NPI:1104966464
Name:KINTARO OKU DC PC
Entity type:Organization
Organization Name:KINTARO OKU DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINTARO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-579-9876
Mailing Address - Street 1:2470 ST ROSE PKWY
Mailing Address - Street 2:STE 306
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-579-9876
Mailing Address - Fax:702-579-9877
Practice Address - Street 1:2470 ST ROSE PKWY
Practice Address - Street 2:STE 306
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-579-9876
Practice Address - Fax:702-579-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty