Healthcare Provider Details

I. General information

NPI: 1023632700
Provider Name (Legal Business Name): ALYSSA OBATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 ULUNIU ST STE 404
KAILUA HI
96734-2534
US

IV. Provider business mailing address

1668 PAULA DR
HONOLULU HI
96816-4316
US

V. Phone/Fax

Practice location:
  • Phone: 808-262-2226
  • Fax:
Mailing address:
  • Phone: 808-218-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14415
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1532
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: