Healthcare Provider Details

I. General information

NPI: 1114361920
Provider Name (Legal Business Name): HONOLULU PAIN RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST SUITE 1564
HONOLULU HI
96814-1956
US

IV. Provider business mailing address

1314 S KING ST STE 1655
HONOLULU HI
96814-1950
US

V. Phone/Fax

Practice location:
  • Phone: 808-924-7246
  • Fax: 808-591-9343
Mailing address:
  • Phone: 808-924-7246
  • Fax: 808-591-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1164
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12860
License Number StateHI

VIII. Authorized Official

Name: DR. DAMIAN SMITH
Title or Position: OWNER
Credential: DC
Phone: 808-924-7246