Individual
TED H. OMURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1609 MERIDIAN AVE, SAN JOSE, CA 95125-5532
(408) 448-8818
Mailing address
1609 MERIDIAN AVE, SAN JOSE, CA 95125-5532
(408) 448-8818
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
DC025988
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
357446700
DEPT. OF LABOR
CA
01
—
5708678
AETNA
CA
01
—
DC0259880
BLUE SHIELD
CA
Enumeration date
08/03/2005
Last updated
09/09/2010
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