Healthcare Provider Details

I. General information

NPI: 1245565613
Provider Name (Legal Business Name): KAILUA WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 KUULEI RD
KAILUA HI
96734-2720
US

IV. Provider business mailing address

228 KUULEI RD
KAILUA HI
96734-2720
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-8181
  • Fax: 808-261-7770
Mailing address:
  • Phone: 808-261-8181
  • Fax: 808-261-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number404
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TYLER D RYAN
Title or Position: OWNER
Credential: DC
Phone: 808-261-8181