Healthcare Provider Details

I. General information

NPI: 1790117869
Provider Name (Legal Business Name): VALERIE QUIJANO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1035 MAMALAHOA HWY SUITE P
KAMUELA HI
96743-8440
US

IV. Provider business mailing address

PO BOX 1018
HONOKAA HI
96727-1018
US

V. Phone/Fax

Practice location:
  • Phone: 808-756-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1254
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: