Healthcare Provider Details

I. General information

NPI: 1760620652
Provider Name (Legal Business Name): AARIES T ODA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 AKAHI ST SUITE 22
LIHUE HI
96766-1106
US

IV. Provider business mailing address

4156 PUAOLE ST
LIHUE HI
96766-1410
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-7100
  • Fax:
Mailing address:
  • Phone: 808-647-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1135
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: