Provider Demographics
NPI:1962594978
Name:WAKITA, MORIHIKO (DC)
Entity type:Individual
Prefix:
First Name:MORIHIKO
Middle Name:
Last Name:WAKITA
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 1:220 W PROSPECT RD STE D
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2000
Mailing Address - Country:US
Mailing Address - Phone:970-224-4852
Mailing Address - Fax:970-224-0928
Practice Address - Street 1:220 W PROSPECT RD STE D
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2000
Practice Address - Country:US
Practice Address - Phone:970-224-4852
Practice Address - Fax:970-224-0928
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2616111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23173Medicare PIN