Healthcare Provider Details

I. General information

NPI: 1245928746
Provider Name (Legal Business Name): AUSTIN THEODORE KOZIOL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1001 KAIMALIE ST STE 106
EWA BEACH HI
96706-6247
US

IV. Provider business mailing address

91-1001 KAIMALIE ST STE 106
EWA BEACH HI
96706-6247
US

V. Phone/Fax

Practice location:
  • Phone: 808-637-2608
  • Fax:
Mailing address:
  • Phone: 808-637-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-1566-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: