Provider Demographics
NPI:1891088795
Name:SHIMABUKURO, SPENCER HUNG WO YIM (DC)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:HUNG WO YIM
Last Name:SHIMABUKURO
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 1:100 W IMPERIAL AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2200
Mailing Address - Country:US
Mailing Address - Phone:310-322-1757
Mailing Address - Fax:310-322-1767
Practice Address - Street 1:100 W IMPERIAL AVE
Practice Address - Street 2:SUITE N
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2200
Practice Address - Country:US
Practice Address - Phone:310-322-1757
Practice Address - Fax:310-322-1767
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor