Provider Demographics
NPI:1831274869
Name:MIRANDA, PHILIP DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:MIRANDA
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 1:74-5620 PALANI RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3640
Mailing Address - Country:US
Mailing Address - Phone:808-331-1205
Mailing Address - Fax:808-329-2748
Practice Address - Street 1:74-5620 PALANI RD
Practice Address - Street 2:STE. 102
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3640
Practice Address - Country:US
Practice Address - Phone:808-331-1205
Practice Address - Fax:808-329-2748
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI23867-5OtherHMSA
HIPM1038195OtherASHN
HI23867-5OtherHMSA
HIPM1038195OtherASHN