Healthcare Provider Details

I. General information

NPI: 1508300351
Provider Name (Legal Business Name): BRAD MCLAUGHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRADLEY MCLAUGHLIN

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LONO AVE SUITE #105
KAHULUI HI
96732-1610
US

IV. Provider business mailing address

2136 KONOU PL APT. #101
KIHEI HI
96753-8775
US

V. Phone/Fax

Practice location:
  • Phone: 808-873-0733
  • Fax:
Mailing address:
  • Phone: 949-547-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberPTA 326
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: