Provider Demographics
NPI:1447541917
Name:KOIKE, MICHITERU (DC, DACBSP, ATC)
Entity type:Individual
Prefix:DR
First Name:MICHITERU
Middle Name:
Last Name:KOIKE
Suffix:
Gender:M
Credentials:DC, DACBSP, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 W EL CAMINO REAL STE 6
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1180
Mailing Address - Country:US
Mailing Address - Phone:408-444-2202
Mailing Address - Fax:
Practice Address - Street 1:970 W EL CAMINO REAL STE 6
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1180
Practice Address - Country:US
Practice Address - Phone:408-444-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor