Healthcare Provider Details

I. General information

NPI: 1982072823
Provider Name (Legal Business Name): MIRANDA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
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: 808-331-1205
  • Fax: 808-329-2748
Mailing address:
  • Phone: 808-331-1205
  • Fax: 808-329-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number916
License Number StateHI

VIII. Authorized Official

Name: DR. PHILIP DAVID MIRANDA
Title or Position: OWNER
Credential: DC
Phone: 808-331-1205