Provider Demographics
NPI:1447346861
Name:KITAMURA-TINTOR, DANIEL VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VINCENT
Last Name:KITAMURA-TINTOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:VINCENT
Other - Last Name:TINTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2900 BROADWAY
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1531
Mailing Address - Country:US
Mailing Address - Phone:650-363-8878
Mailing Address - Fax:
Practice Address - Street 1:2900 BROADWAY
Practice Address - Street 2:SUITE ONE
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1531
Practice Address - Country:US
Practice Address - Phone:650-363-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17328111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0173280Medicare ID - Type Unspecified