Provider Demographics
NPI:1124492673
Name:PACIFIC CHIROPRACTIC, INC
Entity type:Organization
Organization Name:PACIFIC CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AVALLONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:808-871-7745
Mailing Address - Street 1:310 OHUKAI RD STE 312
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7061
Mailing Address - Country:US
Mailing Address - Phone:808-871-7745
Mailing Address - Fax:808-874-1802
Practice Address - Street 1:310 OHUKAI RD STE 312
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7061
Practice Address - Country:US
Practice Address - Phone:808-871-7745
Practice Address - Fax:808-874-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1639211279OtherPERSONAL NPI NUMBER