Healthcare Provider Details

I. General information

NPI: 1184778565
Provider Name (Legal Business Name): PEARL CITY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 KAMEHAMEHA HWY STE 309
PEARL CITY HI
96782-2638
US

IV. Provider business mailing address

803 KAMEHAMEHA HWY STE 309
PEARL CITY HI
96782-2638
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-5553
  • Fax: 808-455-6520
Mailing address:
  • Phone: 808-456-5553
  • Fax: 808-455-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberW20589308-01
License Number StateHI

VIII. Authorized Official

Name: DR. CHRISTOPHER MITCHELL NOWICKI
Title or Position: MEMBER
Credential: D.C., D.A.B.C.O.
Phone: 808-456-5553