Healthcare Provider Details

I. General information

NPI: 1619356870
Provider Name (Legal Business Name): PONO CHIROPRACTIC INSTITUTE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
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: 808-353-1114
  • Fax:
Mailing address:
  • Phone: 808-353-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1227
License Number StateHI

VIII. Authorized Official

Name: DR. HARI SIMRAN SINGH KHALSA
Title or Position: OWNER
Credential: D.C.
Phone: 808-353-1114