Healthcare Provider Details

I. General information

NPI: 1760668446
Provider Name (Legal Business Name): MARK K. ROCCO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2008
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W KAMEHAMEHA AVE
KAHULUI HI
96732-2263
US

IV. Provider business mailing address

33 W KAMEHAMEHA AVE
KAHULUI HI
96732-2263
US

V. Phone/Fax

Practice location:
  • Phone: 808-359-3336
  • Fax:
Mailing address:
  • Phone: 808-359-3336
  • Fax: 719-260-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR-6150
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR-1380
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: