Provider Demographics
NPI:1215348230
Name:HALEIWA CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:HALEIWA CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:SHIGEO
Authorized Official - Last Name:TSUTSUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-637-9752
Mailing Address - Street 1:66-560 KAMEHAMEHA HWY.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712
Mailing Address - Country:US
Mailing Address - Phone:808-637-9752
Mailing Address - Fax:808-637-9752
Practice Address - Street 1:66-560 KAMEHAMEHA HWY.
Practice Address - Street 2:SUITE 5
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712
Practice Address - Country:US
Practice Address - Phone:808-637-9752
Practice Address - Fax:808-637-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-911111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56590Medicare UPIN