Healthcare Provider Details

I. General information

NPI: 1508857632
Provider Name (Legal Business Name): PUKALANI CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 AEWA PL SUITE 12
MAKAWAO HI
96768-8882
US

IV. Provider business mailing address

7 AEWA PL SUITE 12
MAKAWAO HI
96768-8882
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-5599
  • Fax: 808-572-0394
Mailing address:
  • Phone: 808-572-5599
  • Fax: 808-572-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0000362
License Number StateHI

VIII. Authorized Official

Name: DR. ANDREW MAIN JANSSEN
Title or Position: OWNER
Credential: D.C.
Phone: 808-572-5599