Healthcare Provider Details

I. General information

NPI: 1255483954
Provider Name (Legal Business Name): HOGAN AND BRODERSON CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-5620 PALANI RD STE 102
KAILUA KONA HI
96740-3640
US

IV. Provider business mailing address

74-5620 PALANI RD STE 102
KAILUA KONA HI
96740-3640
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-7797
  • Fax: 808-329-2748
Mailing address:
  • Phone: 808-329-7797
  • Fax: 808-329-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number977
License Number StateHI

VIII. Authorized Official

Name: DR. SHANNON MARIE HOGAN
Title or Position: DOCTOR
Credential: D.C
Phone: 808-329-7797