Provider Demographics
NPI:1871291880
Name:YAMADA, MICAH (DC)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:YAMADA
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 1:94-017 KUAHELANI AVE APT 146
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1657
Mailing Address - Country:US
Mailing Address - Phone:808-754-1037
Mailing Address - Fax:808-745-1545
Practice Address - Street 1:1212 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1031
Practice Address - Country:US
Practice Address - Phone:808-678-8467
Practice Address - Fax:808-745-1545
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1560-0111NR0400X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0100XChiropractic ProvidersChiropractorOccupational Health