Healthcare Provider Details

I. General information

NPI: 1699583062
Provider Name (Legal Business Name): KALAHEO CHIROPRACTIC AND MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-2527 KAUMUALII HWY
KALAHEO HI
96741-8309
US

IV. Provider business mailing address

2-2527 KAUMUALII HWY
KALAHEO HI
96741-8309
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY D BANKS
Title or Position: OWNER
Credential: DC
Phone: 847-867-4253