Healthcare Provider Details

I. General information

NPI: 1225385800
Provider Name (Legal Business Name): KALAHEO WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-2527 KAUMUALII HWY
KALAHEO HI
96741-8309
US

IV. Provider business mailing address

PO BOX 895
KALAHEO HI
96741-0895
US

V. Phone/Fax

Practice location:
  • Phone: 808-332-5580
  • Fax: 808-332-5581
Mailing address:
  • Phone: 808-332-5580
  • Fax: 808-332-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GREGORY D BANKS
Title or Position: OWNER
Credential: DC
Phone: 808-332-5580