Healthcare Provider Details

I. General information

NPI: 1518137660
Provider Name (Legal Business Name): DR GERALD J FELCHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date: 06/16/2008
Reactivation Date: 10/15/2009

III. Provider practice location address

4270 KILAUEA RD SUITE I
KILAUEA HI
96754
US

IV. Provider business mailing address

PO BOX 711
KILAUEA HI
96754
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-6844
  • Fax:
Mailing address:
  • Phone: 808-828-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC568
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. GERALD J FELCHER
Title or Position: PRESIDENT
Credential: DC
Phone: 808-828-6844