Provider Demographics
NPI:1174610489
Name:KANO, THOMAS Y JR (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:Y
Last Name:KANO
Suffix:JR
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 1:15520 ROCKFIELD BLVD A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1511 TREAT BLVD
Practice Address - Street 2:100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1094
Practice Address - Country:US
Practice Address - Phone:925-949-8911
Practice Address - Fax:925-949-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0271000OtherBLUE SHIELD
CAV04475Medicare UPIN
CADC0271000Medicare ID - Type Unspecified