1740342427 NPI number — WASSERMAN CHIROPRACTIC INC

Table of content: (NPI 1740342427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740342427 NPI number — WASSERMAN CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASSERMAN CHIROPRACTIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740342427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 E LIPOA ST STE A206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIHEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96753-8193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-283-0097
Provider Business Mailing Address Fax Number:
808-793-2733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 E LIPOA ST STE A206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIHEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96753-8193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-283-0097
Provider Business Practice Location Address Fax Number:
808-793-2733
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMOUYAL
Authorized Official First Name:
SHANA
Authorized Official Middle Name:
LOUANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-283-0097

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  979 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A0250652 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".