Provider Demographics
NPI:1962600114
Name:SHIBUYA, RANDALL K (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:K
Last Name:SHIBUYA
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 1:3615 HARDING AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-737-8677
Mailing Address - Fax:808-738-0380
Practice Address - Street 1:3615 HARDING AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-737-8677
Practice Address - Fax:808-738-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC 230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH000QCBVXMedicare PIN