Provider Demographics
NPI:1972096717
Name:KAWANO, TOSHIYA (DC, DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:TOSHIYA
Middle Name:
Last Name:KAWANO
Suffix:
Gender:M
Credentials:DC, DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 EL CAMINO REAL STE 285
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7129
Mailing Address - Country:US
Mailing Address - Phone:760-683-5858
Mailing Address - Fax:
Practice Address - Street 1:5650 EL CAMINO REAL STE 285
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-683-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18363171100000X
CADC31074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist