Healthcare Provider Details

I. General information

NPI: 1558759258
Provider Name (Legal Business Name): HARI SIMRAN SINGH KHALSA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2015
Last Update Date: 01/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 KAWAIHAU RD
KAPAA HI
96746-1971
US

IV. Provider business mailing address

PO BOX 640
ANAHOLA HI
96703-0640
US

V. Phone/Fax

Practice location:
  • Phone: 510-507-0264
  • Fax:
Mailing address:
  • Phone: 510-507-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1227
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: