Provider Demographics
NPI:1982072823
Name:MIRANDA CHIROPRACTIC
Entity type:Organization
Organization Name:MIRANDA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-331-1205
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty